Life Church - 10445

Applicant's First Name

Applicant's Last Name

Reference's First Name

Reference's Last Name

Reference Address (Street, City, State, Zip Code)

Reference's Phone Number

Reference's Email

What is your relationship to the applicant?

How long have you known the applicant?

How well do you know the applicant?

How would you describe the applicant?

How would you describe the applicant's ability to relate to children and/or youth?

How would you describe the applican't ability to relate to adults?

How would you describe the applicant's leadership abilities?

How would you feel about the applicant as a volunteer with your children and/or youth?

Do you know of any characteristics that would negatively affect the applicant's ability to work with children and/or youth? if so, please describe:

Do you have any knowledge that the applicant has ever been convicted of a crime? If so, please describe:

Please list any other comments you would like to make:

Date: (dd/mm/yyyy)

Signature:

Life Church Reference Reply