Appendix B

 

                                               Confidential Reference Form

 

 

Your name has been given as a reference by                              , who submitted an application to work as a volunteer with one of our youth programs.  We would appreciate your completing this form and returning it in the enclosed envelope so that we may make a decision on the applicant's ability to fulfill this volunteer commitment.  All information will be confidential. Thank you.

 

                                                                        _________________________________________

                                                                        Director of Volunteers

 

How long have you known the applicant? ____________________________________________

 

In what capacity have you known the applicant? ______________________________________

_____________________________________________________________________________

 

Describe the applicant's reliability and willingness to make a commitment such as this: _______

_____________________________________________________________________________

 

Are you aware of any problems that would limit the applicant's ability to fulfill this obligation?

_______ If yes, please explain: ____________________________________________________

_____________________________________________________________________________

 

Would you recommend the applicant for placement in a setting such as ours?  Or, do you feel he or she may be more suited for another type of volunteer agency?  If so, why: ________________

_____________________________________________________________________________

_____________________________________________________________________________

 

Additional comments: ___________________________________________________________

_____________________________________________________________________________

 

 

________________________________________                _____________________________

Signature                                                                                 Date