Please call 777-3534 if you would prefer to complete this reference by phone. All information given is kept strictly confidential and is not shared with the applicant.
Your name:
Your phone number:
Applicant's name:
Date:
1. How long have you known the applicant and in what capacity?
a. How often are you in contact with the applicant?
2. Please indicate your opinion of the applicant in the following areas:
Extremely Good 5
Very Good 4
Somewhat Good 3
Poor
2
Extremely Poor 1
Dependability
Ability to uphold a commitment
Flexibility
Respect for rules
Ability to accept and utilize feedback
Maturity
Ability to role model
3. How does the applicant overcome challenges? (personally or professionally)
4. Have you ever witnessed the applicant to be verbally or physically aggressive?
Yes
No
Please Explain:
5. Describe how the applicant interacts and communicates with other people?
6. Would you trust this applicant to develop a one-to-one relationship with a child you care about?
Yes
No
Please explain:
7. What words would you use to describe the applicant?
8. What do you think is the motivation behind the applicant pursuing mentorship?
9. Are you aware of any difficulties in the applicant's personal life, which you feel may affect their ability to mentor?
Yes
No
Please Explain:
10. Is there anything else about the applicant that you would like to share?
The above information is accurate and true to the best of my knowledge.
Date
Thank you for completing the reference form. If you have any questions please contact us at 403-777-3534 or enrol@bbbscalgary.com
