Nurse/Adult Volunteer Reference Form

CONFIDENTIAL REFERENCE FORM

Adult Volunteer/Nurse Position
Your Name*

First NameLast Name
What reference were you asked to be?*

Employer/SupervisorPastorFriend
To help us determine the applicant's qualifications to serve as a member of the Trout Creek Bible Camp staff, please answer the following questions for each tendency according to your knowledge of the applicant.
Applicant's Name*

First NameLast Name

Evaluation of Applicant

Rows	Always	Frequently	Usually	Occasionally	Rarely	Not Observed
Strong Moral Character/Integrity
Emotional Instability
Good Sense of Humor
Strong Leadership Ability
Good Listener
Dishonest
Very Reliable
Aware of Social Cues & Surroundings
Respect of Authority / Rules
Poor Time Management
Flexibility
Takes Initiative
Teachable
Excellent Ability to Work with Others
Relates well with Others
Willingness to Serve
Strong Work Ethic
Works to the best of his/her ability

How long have you known the applicant?*
What kind of relationship have you had with the applicant?*
How well do you know the applicant?*

Somewhat wellModerately WellVery WellOther
Please list 2-3 of the applicant's strengths & 2-3 areas where growth is needed.*
Do you know of any characteristics of the applicant that would negatively affect their ability to work with or around children and/or youth?*
Would you be willing to place your child and/or youth under the direct charge & influence of this applicant?*

YesNoOther
How would you describe the applicant's ability to relate to adults & peers?*
To the best of your knowledge has the applicant been involved with any of the following: marijuana use, tobacco use, alcohol use, illegal drugs, crime, and/or sexual misconduct?*

Applicant's Spiritual Life

Rows	Always	Frequently	Usually	Occasionally	Rarely	Not Observed
Active in Church and/or Small Groups
Spirit-Controlled Actions & Attitudes
Overflowing with Peace & Joy
Demonstrates Christ-likeness
Strong Devotional Life / Bible reading
Easily shares their faith
Exhibits Spiritual Maturity
Consistent Prayer Life
Integrates Bible into Daily life

Does the applicant appear to be growing in his/her spiritual life? List any examples that come to mind.*
Please describe the applicant's family & their dynamics from what you've observed.*

Please indicate your recommendation of the applicant:
Please indicate your recommendation of the applicant:*

Enthusiastically recommendRecommendRecommend with hesitationDo not recommend
If you are recommending this applicant, is it because of what they can contribute to Trout Creek or what being at Trout Creek could do for them?*

Reference Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Reference E-mail*
example@example.com
May we contact you if we have any further questions?

YesNo

CONFIDENTIAL REFERENCE FORM