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Confidential Reference Form
Pleasant Hill Outdoor Center |
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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. |
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Applicant's Name: (please be careful to enter accurately) |
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First |
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Last |
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What is your relationship to the applicant? (check all that apply) |
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Pastor/ Minister |
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Teacher |
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Employer |
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Friend |
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Other
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How Well do you know the applicant? (check all that apply) |
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Very Well |
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Employee |
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Somewhat Well |
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Business |
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Acquaintance |
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Classroom |
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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. |
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Fulfils Obligations |
Takes obligations to others seriously |
Usual fulfils obligations |
Little respect for fulfilling obligations |
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Flexibility |
Naturally Flexible |
Will be flexible when asked, but can go with the flow |
Prefers their own way and lets others know it |
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Emotional Balance |
Very well balanced |
Has their moments |
Often unstable |
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Response to Authority |
Accepts authority well |
Generally responds to authority |
Know to struggle with authority |
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Christian Maturity |
Mature beyond their age |
Maturity consistent with age |
Lacks maturity for age |
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Relationship with Others |
Sought by others |
Liked by others |
Tolerated by others |
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Leadership Ability |
Naturally followed by others |
Can lead if given directions |
Fits best in a group when following |
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Temper Control |
rarely loses composure |
Generally even tempered |
Struggles with temper control |
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Tact |
Tactful even in tough situations |
Generally tactful |
Lacking in tact |
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Does the applicant appear to have a growing and sincere relationship with God? |
Yes/ probably |
No/ I doubt it |
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Insufficient information to comment |
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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 |
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If yes, please explain: |
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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 |
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If yes, please explain: |
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Would you expect the applicant's work to be: |
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Superior |
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Good |
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Fair |
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Poor |
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I verify my identity by checking this box to the person named here. |
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Your Name |
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Date |
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Your Phone* |
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Your E-Mail* |
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*We may contact you briefly by phone to verify the authenticity of this reference. |
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