Ministry Personnel Reference Form
____________________has applied to be on staff / volunteer for Summer STEAM & Sports
Camp / Youth Robotics Leadership Camp 2023 and has indicated on their application that you
might be willing to act as a personal and/or professional reference. We have a program in our
church called Plan to Protect® which is designed to protect our Children, Youth and Vulnerable
Adults as well as our volunteers. We perform reference checks on all our employees and
volunteers working in our ministries. Your response will remain confidential.
Thank you for your cooperation.
Your Name (First and Last) __________________________________________
Address ___________________________________________________________________
1. Describe your relationship with this person.
___________________________________________________________________________
2. How long have you known this person? Circle one below. In what capacity? Please explain
in detail.
Less than 2 Years
2 to 5 Years
More than 7 Years
___________________________________________________________________________
3. Please use the following scale to respond to the following:
1 – low 2 – below average 3 – average 4 – very good
5 – excellent
How would you rate this individual in the following areas?
a. Ability to work with other employees
1
2
3
4
5
b. Ability to follow through on commitments
1
2
3
4
5
c. Ability to relate to Children or/and Youth
1
2
3
4
5
d. Level of spiritual maturity
1
2
3
4
5
e. Level of maturity in work force
1
2
3
4
5
4. What is the applicant’s greatest strengths and weaknesses?
___________________________________________________________________________
5. Would you entrust the care of your Children, Youth or Vulnerable Adults to the candidate
without any concern, reservation, or hesitation? Please circle one. If so, please explain.
YES
NO
___________________________________________________________________________
6. Do you have concerns regarding this candidate working with Children, Youth and Vulnerable
Adults? Please circle one. If so, please explain.
YES
NO
___________________________________________________________________________
7. What can you tell me about candidate’s personality? How does this candidate react to
stressful situations?
____________________________________________________________________________
8. How would you describe the candidate's reliability and dependability?
___________________________________________________________________________
___________________________________________________________________________
9. What was one of the candidate's most memorable accomplishments while working with you?
___________________________________________________________________________
___________________________________________________________________________
10. We are committed to helping the candidate succeed in their new role and grow in their
career. What would you say the candidate needs most to be successful in their new position?
___________________________________________________________________________
___________________________________________________________________________
11. Is there anything else you might be able to tell us about this individual that would help us
to make an employment decision.
___________________________________________________________________________
___________________________________________________________________________
Signature __________________________________________________________________
Printed Name ______________________________________ Date ____________________
Organization: _____________________________ Title: ______________________________
E-mail address: _________________________Phone Number: _________________________