Reference Form

Dear Referee,
The person who has sent you the link to this form has applied to be a student, staff member, intern or mission builder(volunteer) with Youth With A Mission (YWAM) Tasmania. From your knowledge of the applicant, please comment on the following areas to help us assess the applicant's suitability. These comments will be kept in total confidence, although we fall under the Federal Privacy Act, which means that applicants do have access to their files upon request.

Applicant's Name Applicant's Name Title First Last Suffix
The applicant is applying to be a:

The applicant is applying to be a: Student Staff Intern (student + staff) Mission Builder (volunteer) Boarder Outreach team member
Your Full Name Your Full Name Title First Last Suffix
I am filling this form in as a...

I am filling this form in as a... Pastor/Spiritual Leader Employer/Business Associate/Teacher Friend DTS Leader/Staff/One-on-one
What is your relationship to the applicant?
How long have you known the applicant?
On a scale of 1-10 (Where 10 is very well and 1 is not very well): How well do you feel you know the applicant?
Must be a number between 1 and 10

Please rate the applicant on a scale of 1 to 5 (5 being exceptional, 1 being extremely poor). Please comment on any areas that are below 3
	1: Extremely Poor	2	3	4	5: Exceptional
Initiative	Initiative1: Extremely Poor	Initiative2	Initiative3	Initiative4	Initiative5: Exceptional
Social Adaptability	Social Adaptability1: Extremely Poor	Social Adaptability2	Social Adaptability3	Social Adaptability4	Social Adaptability5: Exceptional
Concern for Others	Concern for Others1: Extremely Poor	Concern for Others2	Concern for Others3	Concern for Others4	Concern for Others5: Exceptional
Ability to Follow	Ability to Follow1: Extremely Poor	Ability to Follow2	Ability to Follow3	Ability to Follow4	Ability to Follow5: Exceptional
Leadership Abilities	Leadership Abilities1: Extremely Poor	Leadership Abilities2	Leadership Abilities3	Leadership Abilities4	Leadership Abilities5: Exceptional
Judgment	Judgment1: Extremely Poor	Judgment2	Judgment3	Judgment4	Judgment5: Exceptional
Emotional Stability	Emotional Stability1: Extremely Poor	Emotional Stability2	Emotional Stability3	Emotional Stability4	Emotional Stability5: Exceptional
Personal Appearance	Personal Appearance1: Extremely Poor	Personal Appearance2	Personal Appearance3	Personal Appearance4	Personal Appearance5: Exceptional
Health	Health1: Extremely Poor	Health2	Health3	Health4	Health5: Exceptional
Willingness to Serve	Willingness to Serve1: Extremely Poor	Willingness to Serve2	Willingness to Serve3	Willingness to Serve4	Willingness to Serve5: Exceptional
Ability to Work with Others	Ability to Work with Others1: Extremely Poor	Ability to Work with Others2	Ability to Work with Others3	Ability to Work with Others4	Ability to Work with Others5: Exceptional
Reliability	Reliability1: Extremely Poor	Reliability2	Reliability3	Reliability4	Reliability5: Exceptional
Cooperativeness	Cooperativeness1: Extremely Poor	Cooperativeness2	Cooperativeness3	Cooperativeness4	Cooperativeness5: Exceptional
Flexibility	Flexibility1: Extremely Poor	Flexibility2	Flexibility3	Flexibility4	Flexibility5: Exceptional
Disposition	Disposition1: Extremely Poor	Disposition2	Disposition3	Disposition4	Disposition5: Exceptional
Punctuality	Punctuality1: Extremely Poor	Punctuality2	Punctuality3	Punctuality4	Punctuality5: Exceptional
Academic Capacity	Academic Capacity1: Extremely Poor	Academic Capacity2	Academic Capacity3	Academic Capacity4	Academic Capacity5: Exceptional
Work Capacity	Work Capacity1: Extremely Poor	Work Capacity2	Work Capacity3	Work Capacity4	Work Capacity5: Exceptional
Financial Responsibility	Financial Responsibility1: Extremely Poor	Financial Responsibility2	Financial Responsibility3	Financial Responsibility4	Financial Responsibility5: Exceptional
Work Ethic	Work Ethic1: Extremely Poor	Work Ethic2	Work Ethic3	Work Ethic4	Work Ethic5: Exceptional

Please explain
In your experience of the applicant, do they exhibit any of the following behaviours at times? Please check if yes:

In your experience of the applicant, do they exhibit any of the following behaviours at times? Please check if yes: Impatient Intolerant Argumentative Domineering Addictive Behaviours Critical of Others Easily Embarrassed Easily Offended Discouraged Unable to Cope with Stress Easily Worried Anxious Nervous/Tense Given to "Moods" Erratic in Attitudes None of the Above Other Other
How would you describe the applicant's Christian experience?

How would you describe the applicant's Christian experience? Mature Contagious and Growing Genuine but Mild Over-emotional Superficial
Do you support the applicant's decision to do a school/course/outreach with YWAM?

Do you support the applicant's decision to do a school/course/outreach with YWAM? Yes No
Please explain.
Do you support the applicant's decision to join staff with YWAM?

Do you support the applicant's decision to join staff with YWAM? Yes No
Please explain.
Would you recommend the applicant?

Would you recommend the applicant? Yes Yes, but hesitantly No
Please explain.
Please give a description of the applicant's general work skills and abilities or disabilities.
Please comment on the applicant's willingness to follow instructions.
Please comment on the applicant's ability to get along with others.
Does the individual display high moral standards?

Does the individual display high moral standards? Yes - Consistently Most of the time Sometimes No
Please explain
The applicant may be doing work with children and youth. Do you recommend this person, with regard to their actions, behaviour and moral decisions, to work with minors?

The applicant may be doing work with children and youth. Do you recommend this person, with regard to their actions, behaviour and moral decisions, to work with minors? Yes No
Please explain
Do you know of any prejudices the applicant has towards any people group or culture?

Do you know of any prejudices the applicant has towards any people group or culture? No Yes
Please explain
What involvement does the applicant have with his/her local church?
Please comment on the applicant's family background
What would you say are the applicant's strengths/weaknesses?
Which of the following best describes the applicant's maturity and stability?

Which of the following best describes the applicant's maturity and stability? Outstandingly mature. Has proven his/her ability to operate under stress and pressure More mature and emotionally stable than average Possesses adequate emotional stability and maturity Doubtful. Experience has show that the applicant might not be able to endure stress. Applicant has frequently demonstrated signs of inability to cope with stress-such as rage or withdrawal; is erratic in attitude and action; or has demonstrated emotional instability in other ways.
Any other comments that you would like to make in reference to this applicant:
Your choice of contact method, should we have further questions or if there is anything further you would like to discuss with us about the applicant:

Your choice of contact method, should we have further questions or if there is anything further you would like to discuss with us about the applicant: Phone Call Email
Your Phone Number
Your Email Address
Would you like to know more about YWAM?

Would you like to know more about YWAM? Yes No