2025 Airfield 4-H Center Reference Form

Airfield 4-H Center Reference Form
You have been listed as a reference by someone who has applied for a position at the Airfield 4-H Center.

The position requires a high degree of responsibility, integrity, maturity, and organization. We would appreciate your honest response to the questions listed below. Your input will remain confidential.

Joey Patterson

Program Director

jpatt024@vt.edu

757-899-4901

Virginia Cooperative Extension is a partnership of Virginia Tech, Virginia State University, the U.S. Department of Agriculture, and local governments. Its programs and employment are open to all, regardless of age, color, disability, gender, gender identity, gender expression, national origin, political affiliation, race, religion, sexual orientation, genetic information, military status, or any other basis protected by law.
Your name:*

First NameLast Name
Your phone number:*

Area CodePhone Number
Your email:*
Title or Role/Business or Employer*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name of the Applicant you are providing the Reference for:*

First NameLast Name
How long have you known the applicant?*
In what capacity have you known the applicant?*
Highly recommendRecommend without reservationRecommend with reservationDo not recommend
Is there anything else you would like to share about the candidate and his/her/their ability to succeed in this role?*
Indicate how you rate the candidate in the following competencies. If you do not have enough experience in a specific competency area, please leave that field blank. Thank you.
Working with others

Young children age 9-13

	1	2	3	4	5

1 is Poor, 5 is Excellent

Peers

	1	2	3	4	5

1 is Poor, 5 is Excellent

Adults

	1	2	3	4	5

1 is Poor, 5 is Excellent

Values Diversity

	1	2	3	4	5

1 is Poor, 5 is Excellent

Perspective-taking (ability to consider from another's point-of-view)

	1	2	3	4	5

1 is Poor, 5 is Excellent

Leadership Skills

Planning & organization

	1	2	3	4	5

1 is Poor, 5 is Excellent

Manages time efficiently

	1	2	3	4	5

1 is Poor, 5 is Excellent

Demonstrate initiative

	1	2	3	4	5

1 is Poor, 5 is Excellent

Exercises sympathy or empathy when appropriate

	1	2	3	4	5

1 is Poor, 5 is Excellent

Inspires confidence

	1	2	3	4	5

1 is Poor, 5 is Excellent

Exercises good judgement

	1	2	3	4	5

1 is Poor, 5 is Excellent

Responsibility

Follows policies & procedures

	1	2	3	4	5

1 is Poor, 5 is Excellent

Concern for camper safety & welfare

	1	2	3	4	5

1 is Poor, 5 is Excellent

Respects Authority

	1	2	3	4	5

1 is Poor, 5 is Excellent

Demonstrate maturity in challenging situations

	1	2	3	4	5

1 is Poor, 5 is Excellent

Decision-making skills

	1	2	3	4	5

1 is Poor, 5 is Excellent

Ability to follow through with tasks to completion

	1	2	3	4	5

1 is Poor, 5 is Excellent

Communication

Teaching skills

	1	2	3	4	5

1 is Poor, 5 is Excellent

Listening skills

	1	2	3	4	5

1 is Poor, 5 is Excellent

Patient

	1	2	3	4	5

1 is Poor, 5 is Excellent

Team player

	1	2	3	4	5

1 is Poor, 5 is Excellent

Ability to give clear instructions

	1	2	3	4	5

1 is Poor, 5 is Excellent

Ability to express self

	1	2	3	4	5

1 is Poor, 5 is Excellent

Other Competencies

Ability to receive feedback

	1	2	3	4	5

1 is Poor, 5 is Excellent

Integrity

	1	2	3	4	5

1 is Poor, 5 is Excellent

Stress Management

	1	2	3	4	5

1 is Poor, 5 is Excellent

Positive attitude

	1	2	3	4	5

1 is Poor, 5 is Excellent

Commitment

	1	2	3	4	5

1 is Poor, 5 is Excellent

Dependability

	1	2	3	4	5

1 is Poor, 5 is Excellent

Additional thoughts/comments:
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