Reference for Child/Youth Volunteer or Childcare Worker

An individual has expressed interest in working with children or youth in our ministry. The candidate has listed you as a reference. In order for our organization to properly evaluate the qualifications of this worker candidate, we are asking you to complete this form with your honest opinions and impressions of the candidate. Please submit the completed form to our organization as soon as possible. Thank you for your assistance.

Name of the Childcare Worker Applicant

First Name

Last Name

Your Name

First Name

Last Name

How long have you known the ministry worker candidate?

In what capacity have you come to know this individual?

i.e. coworker, neighbor, friend, etc.

In your opinion, is the above worker candidate fully qualified to work with children and youth? If no, please explain.

With what children age group(s) would you say the applicant would work well?

Check all that apply.

Nursery-Kindergarten (Birth-5 years)

Elementary (1st-5th Grades)

Middle School (6th-8th Grades)

High School (9th-12th Grades)

What concerns, if any, would you have in allowing this individual to work with children or youth?

Are you aware of anything in the candidate's background, personality, or behavior that could in any way pose a threat to children or youth? If yes, please explain.

Additional comments or explanations:

The above information is true and correct to the best of my knowledge.

By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.

Date Signed

YYYY

Reference for Child/Youth Volunteer or Childcare Worker

Office Hours

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