NYSUM Pastoral Reference Form

NYSUM Pastoral Reference Form

(All information submitted is strictly confidential)
Pastor's Name*

First NameLast Name
Name of Applicant you're referring*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Title/Position (if not Senior Pastor) within Church
Church Name*
How long have you known the applicant?*
# of months & years
Please answer the following questions regarding the applicant and rate accordingly to the best of your judgement :
YESNO
Starts but doesn't finishConscientious, dependableDoes only what is assignedSeeks Additional TasksMeets average expectationsOther (Specify)
UnreliableConscientousSomewhat dependableAssumes much responsibilityUsually dependableOther (Specify)
RebelliousObedientQuestions AuthorityHumble but proactiveIndifferently submissiveOther (Specify)
UnwillingEagerReluctantAlways willing & availableAverage dispositionOther (Specify)
UncooperativeCooperativePresents oppositionEnthusiasticIndependantOther (Specify)
Self-centered, needs to have own wayWorks well with othersFrequently causes frictionUplifts the team, helps meets goalUsually CooperativeOther (Specify)
Always a followerGood leadershipTries but fails at leadershipInspires & raises up new leadersOccasionally assumesOther (Specify)
Not interested in growthAverage spiritually but growingImmature, superficial faithMature, inspires growth in othersYoung in faith, new believerOther (Specify)
Little, if anyNormal, healthy spirituallyShallow spiritual walkIntercessor, grounded in the WordStruggles but pursues growthOther (Specify)
QuestionableWithout reproachLacks principlesInspires emulation, good exampleAverage characterOther (Specify)
Nervous, poor self-controlGood self-controlMood swings, emotionally drivenExcellent under stressUsually well-balancedOther (Specify)
Anti-socialShow Interest in helping othersSelf-centeredActively helping & serving othersCommon courtesyOther (Specify)
DetrimentalConsistenly good influencePassive, not much influenceOvertly wholesome influenceVarying influenceOther (Specify)
Avoided by othersWell liked by othersToleratedSought by othersLiked by othersOther (Specify)
Careless in dressNeat and well presentedSlightly CarelessAttractive and outstandingAverage appearanceOther (Specify)
Christian ServiceTravel/AdventureEscape CircumstancesDesire to spread the GospelReceive HelpDesire to help othersOther (Specify)
Definitely suited & Fully RecommendedSlight reservationsAverage applicantNot suitable at this timeOther (Specify)
If there is any other information you feel will help us review the applicant better, or that should know in advance prior to making any decisions, please use the space below:

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