Reference Form - Campus Church

Reference questionnaire

Please complete the form in its entirety and honestly. Your responses will not be shared with the individual.

Your Name

Phone

Email

List the name of the person you are giving a reference for:

What is your connection with this individual?

How long have you known the individual?

What is your knowledge of this person’s work with children/youth?

How would you describe this person’s manner of interacting with children/youth?

Based on your observation, is this person reliable and dependable?

Would you feel comfortable with this person being alone with a small group of children/youth for a period of time? Why or why not?

Do you have any concerns we should know about regarding this person’s ability to work with children/youth?

Were you ever made aware of circumstances in which this person’s care of children/youth was called into question or criticized? If yes, please describe the circumstances.

Were you ever made aware of any criminal or civil investigations or actions taken against this person? If yes, please describe the circumstances.

Do you recommend this person to work with children/youth? Why or why not?

Is this person eligible to work with your organization’s children again in the future? If no, why not?

Additional notes or comments:

I do hereby confirm that the information furnished above is true to the best of my knowledge and belief.

Signature—Type Your Name Here

Reference questionnaire

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