Contact
General Information
info@phoc.org
Director
director@phoc.org 4654 Pleasant Hill Rd.
Perrysville, OH 44864
419 938-3715

 
Confidential Reference Form
Pleasant Hill Outdoor Center
To Whom it May Concern;
Thank you for taking time to complete this reference on behalf of the applicant. I'm sure you'll understand that because we work with children your honest opinion is most helpful. Please be sure to enter the correct applicant name in the space provided to avoid confusion. We will almost certainly contact you briefly by phone to verify the authenticity of this reference. Thank you.
Applicant's Name: (please be careful to enter accurately)
First Last
What is your relationship to the applicant? (check all that apply)
Pastor/ Minister Teacher
Employer Friend
Other
How Well do you know the applicant? (check all that apply)
Very Well Employee
Somewhat Well Business
Acquaintance Classroom
Please check the description that best fits the applicant. If in doubt, check more than one. Leave a question blank if you do not feel you do not know.
Fulfils Obligations Takes obligations to others seriously Usual fulfils obligations Little respect for fulfilling obligations
Flexibility Naturally Flexible Will be flexible when asked, but can go with the flow Prefers their own way and lets others know it
Emotional Balance Very well balanced Has their moments Often unstable
Response to Authority Accepts authority well Generally responds to authority Know to struggle with authority
Christian Maturity Mature beyond their age Maturity consistent with age Lacks maturity for age
Relationship with Others Sought by others Liked by others Tolerated by others
Leadership Ability Naturally followed by others Can lead if given directions Fits best in a group when following
Temper Control rarely loses composure Generally even tempered Struggles with temper control
Tact Tactful even in tough situations Generally tactful Lacking in tact
Does the applicant appear to have a growing and sincere relationship with God? Yes/ probably No/ I doubt it
Insufficient information to comment
Do you have any knowledge of this person ever being convicted of a crime, other than a minor traffic offense including any sexual offence crimes? Yes No
If yes, please explain:
Is there any reason you are aware of this applicant should NOT be permitted to work with children in a residential camp setting? Yes No
If yes, please explain:
Would you expect the applicant's work to be:
Superior Good
Fair Poor
I verify my identity by checking this box to the person named here.
Your Name Date
Your Phone* ( )
Your E-Mail*
*We may contact you briefly by phone to verify the authenticity of this reference.