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)	2	3 (Average)	4	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)