Confidential Reference Form

Reference cannot be filled out by a relative or peer.

Mark the checkbox that best represents the applicant each category (1 = lowest, 10 = highest)*

	N/A	1	2	3	4	5	6	7	8	9	10
Quality of Work
Punctuality
Demeanor
Initiative
Leadership
Safety
Interpersonal Relationships
Follow Up
Teachability
Respects Leadership
Team Worker
Conflict Resolution
Capacity to Work with Youth/Children

Please check any traits below which characterize this person:*
- Easily Irritated
- Fun
- Intolerant
- Argumentative
- Humorous
- Nervous
- Responsible
- Compassionate
- Impatient
- Easily Angered
- Discouraged
- Happy
- Bull Headed
- Pleasant
- Easily Embarrassed
- Depressed
- Dishonest
- Friendly
- Moody
- Complainer
- Cooperative
- Cannot take a Joke
- Energetic
- Conscientious
- Patient
- Committed
- Influential
- Creative
- Always Asking "Why"
- Sullen
- Positive
- Tense
- Loving
- Critical of Others
- Legalistic
- Frequently Worries
- Intelligent
- Giving
- Caring
- Prompt
- Sensitive
- Task-Oriented
- Good Common Sense
- People-Oriented
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 and group setting?*
- Yes
- No
I would...*
- Strongly Recommend
- Recommend
- Recommend with Reservation
- Not Recommend Hiring the Applicant
If "Not Recommended" please comment:
I expect the applicant's work to be...*
- Poor
- Average
- Good
- Superior
Contact Information
Your Name*
First Last
Your Phone*
Your Email*
Your Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone
This field is for validation purposes and should be left unchanged.

Applicant Information