Register A Student

Register A Student

Reference Form

Reference Form

This form should be completed for applicants of Avenue941. We desire to offer a safe, excellent and child friendly atmosphere at Avenue941, for all our children’s programs. We ask all volunteers and staff to complete applications and provide recommendations to us through references.

All information is held in strict confidence, with very limited access to this private information. Thank you, in advance, for assisting us through your thoughtful responses to this request.

© MinistrySafe 2016. All Rights Reserved. Base policy material created by MinistrySafe, program-specific edits added by Avenue941

Your Name(Required)

First Last

Your Email(Required)

Applicant's Name(Required)

First Last

For how long have you known this applicant?(Required)

Less than one year

1-5 years

6-10 years

11 years+

In what capacity have you worked with or known this applicant?(Required)

What strengths and weaknesses have you observed in this applicant?(Required)

What are the applicant's hobbies and recreational activities?(Required)

How would you rate this applicant's work ethic?(Required)

Where 1 = Poor and 5 = Exceptional.

How well does this applicant work with a team?(Required)

Where 1 = Poor and 5 = Exceptional.

How would you rate this applicant's ability to work well with children and youth?(Required)

Where 1 = Poor and 5 = Exceptional.

Rate this applicant's level of dependability.(Required)

Where 1 = Poor and 5 = Exceptional.

Rate this applicant's ability to follow through with tasks.(Required)

Where 1 = Poor and 5 = Exceptional.

Rate this applicant's level of integrity.(Required)

Where 1 = Poor and 5 = Exceptional.

We are looking for someone who can stay calm and control frustration even under very frustrating conditions with children. How would you rate the applicant's ability to be patient and stay calm?(Required)

Where 1 = Poor and 5 = Exceptional.

Have you ever known the applicant to use harsh or abusive discipline with a child?(Required)

Would you be comfortable placing one of your own children in the care of the applicant? Why or why not?(Required)

How would you rate the applicant's ability to relate with adults?(Required)

Where 1 = Poor and 5 = Exceptional.

We need a person who can be supportive and understanding to a child or student. How would you rate the applicant's ability to be genuinely supportive and understanding to a person in need?(Required)

Where 1 = Poor and 5 = Exceptional.

Are you aware of any significant stressors recently experienced by the applicant? (An example would be a death in the family, divorce, or financial crisis.)(Required)

Would this applicant do well in a growing organization that requires lots of flexibility and ability to be a self-starter?(Required)

Yes

No

How would you recommend this applicant for employment at Avenue941?(Required)

Where 1 = Poor and 5 = Exceptional.

Would you recommend this applicant for a leadership role?(Required)

Yes

No

What else would you like to share to explain the answers you have given above?(Required)

Signature

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