Professional/Personal Reference
You have been asked to provide a reference for a volunteer applicant of Centrica Care Navigators. Please consider the questions carefully and provide any additional information you think would help us evaluate their application. All information you provide will be kept confidential. If you have any questions, please call 269-345-0273.Thank you for your prompt attention.
Name of Applicant (Who are you doing the reference for):
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Your Name
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First Name
Last Name
Your Phone Number
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-
Area Code
Phone Number
Your E-Mail
How well do you know the applicant?
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Please Select
Very Well
Well
Slightly
What is your relationship to the applicant?
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How long have you known the applicant?
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Have you had any contact with the applicant in the last 12 months?
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Yes
No
Please rate the applicant on the following characteristics.
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Poor
Fair
Average
Good
Excellent
Adaptability
Dependability
Initiative
Judgment
Maturity
Integrity
Personal Appearance
Empathy
Communication Skills
Do you recommend that this applicant become a volunteer for Centrica Care Navigators?
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Yes
No
Comments
Date
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/
Month
/
Day
Year
Date
Signature
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Submit
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