Confidential Reference Form

Confidential Reference Form

Please answer the questions to the best of your knowledge of the applicant. References should not be filled out by a relative. Thank you!
Your Name *

First Name Last Name
Name of Applicant (Person this is for) *

First Name Last Name
Applying for Position *
How long have you known this person? *
In what capacity? *
What basis do you know this person on? *

one-on-one small group (1-29) medium group (30-99) large group (100+)

Please rank the applicant in the following areas:

1 (Poor)

3 (Average)

5 (Superior)

Teachable

Promptness

Follows Instructions

Outgoing

Emotional Balance

Capacity to Work with Children

Capacity to Work with Youth

Fulfills Obligations

Sense of Humor

Temper Control

Follow-Through Ability

Energetic

Trustworthy

Gets Along with Others

Tact

Leadership Ability

Friendly

Moral Reputation on Campus

Humility

Please comment on the applicant's spiritual life. *
Would you completely trust this individual to guide and care for your child in a one-on-one or group setting? *
Explain below if hesitant.
Explain:
To your best knowledge, has this applicant ever been expelled or suspended from school or employment or charged with, arrested for, or convicted of any offense or violation of any statute or law? *
I would: *
Hiring this applicant.
What specific reason would you give for hiring or not hiring the applicant? *
I expect the applicant's work to be: *
Your Contact Information: (References may be contacted for verification)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number
Email Address
Should be Empty: