This form is to help you give a character reference for an applicant seeking a volunteer position with the City Mission of Schenectady. Please help us evaluate this applicant by filling in the confidential information requested. Give your appraisal in as many areas as you feel you can answer. Thank you for your assistance in making this a meaningful volunteer assignment for the applicant.

Your Info:

Your Name

Organization (optional)

Address

City

State

Zip

Day Telephone (Optional)

Evening Telephone (Optional)

Your Email

How long have you known the applicant?

Describe your relationship to the applicant

Applicant Info:

Name of applicant this reference is for

Do you recommend this applicant?
---YesNo

If no, please describe why not

Do you know any reason why this applicant should not work with children?
---YesNo

If “Yes” please describe the reason

To the best of your ability, select the option that bests describes the applicant's...
Communication
---ExcellentAbove AverageAverageBelow AverageUnknown

Relating to youth
---ExcellentAbove AverageAverageBelow AverageUnknown

Cooperation
---ExcellentAbove AverageAverageBelow AverageUnknown

Emotional Stability
---ExcellentAbove AverageAverageBelow AverageUnknown

Initiative
---ExcellentAbove AverageAverageBelow AverageUnknown

Judgment/Common Sense
---ExcellentAbove AverageAverageBelow AverageUnknown

Leadership
---ExcellentAbove AverageAverageBelow AverageUnknown

Manner/Personal Appearance
---ExcellentAbove AverageAverageBelow AverageUnknown

Reliability
---ExcellentAbove AverageAverageBelow AverageUnknown

For each of the following, select the most appropriate word that best describes the general nature of applicant:
---PositivePassiveNegative ---Well-balancedEasily OffendedAccepts Criticism ---EmpatheticFriendlyAloof ---DedicatedSearchingUncommitted

Applicants strengths

Applicants weaknesses

Please include any other appropriate information regarding this applicant that you feel we should know

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