THIS REFERENCE FORM WILL NOT BE SHOWN TO, OR DISCUSSED WITH, THE APPLICANT.

Reference Name: *
Reference Name:
Applicant's Name: *
Applicant's Name:
How long have you known the applicant?
2 ) *
In what relationship:
3 ) *
As far as you know, has this person had any history of child abuse or molestation?
4 ) *
Check any characteristics or traits, which you have noticed in the applicant:
5 ) *
Have you ever observed the applicant with children?
6 ) *
If Yes, what was your observation?
7 ) *
Do you have any reservations in recommending this person?
8 ) *
Physical Condition
9 ) *
Sociability or friendliness
10 ) *
Achievement (ability to formulate, execute, & carry plans to conclusion)
11 ) *
Leadership (ability to inspire others & maintain their confidence)
12 ) *
Teamework ( ability to work with others)
13 ) *
Responsiveness (to feelings and needs of others)
14 ) *
Emotional Adjustment
15 ) *
Teachable
16 ) *
Perseverance (in completing tasks)
17 ) *
Self-Image
18 ) *
Do you have any reason to doubt applicant's personal integrity?