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Reference Form

Thank you for taking some time out of your busy day to complete the form below.
The information you provide on behalf of the volunteer candidates you are representing will be kept confidential.
Please answer honestly and openly.

Personal Information

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Your Name *

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Last

Name of Volunteer Candidate *

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Last

Your Address *

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City

State

Zip Code

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Your Email *

Your Phone Number *

Your role / title / position *

Your organization / employer *

Please describe your relationship with, or in what capacity you know, the volunteer candidate: *

How long have you known the volunteer candidate? *

Do you believe the volunteer candidate is capable of providing responsible supervision to children and youth? *

If no, please explain: *

Please describe any concerns you may have, if any, about this candidate's ability to serve based on aspects of their physical, mental, emotional, spiritual, or social behaviors or conditions: *

How comfortable would you be with this candidate caring for your own child (if you have children or were to have children)? *

Very comfortable Comfortable Uneasy Very uneasy

How would you rate this candidate's communication skills? *

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How would you rate this candidate's responsibility and reliability? *

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How would you rate this candidate's ability to work well with others and be a team player? *

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How would you rate this candidate's ability to understand and follow directions? *

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Which age groups do you feel this candidate is best gifted to serve? (Select all that apply) *

Infants / toddlers Preschool (ages 3-5) Young elementary (K-2 grade) Upper elementary (3-5 grade) Middle school (6-8 grade) High school (9-12 grade) I do NOT believe they are fit to serve at this time

Do you have any other comments or concerns you would like to share regarding this volunteer candidate? *

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201 N. 8th Street, PO Box 11, Upland, IN 46989 | (765) 998-2985office@piercechurch.org

201 N. 8th Street, PO Box 11, Upland, IN 46989 | (765) 998-2985
office@piercechurch.org