Référence pour la vérification des antécédents en vue d’un travail auprès de personnes vulnérables

Vulnerable Sector Reference

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Provided for (Volunteer Name):*

Email (Volunteer Email):*

Provided by (Your Name):*

Email (Your Email):*

Phone (Your Phone):*

1. How long have you known the applicant and in what capacity?*

2. Did the applicant report directly to you?*

3. What was the applicant’s role in your organization?*

4. How long did the applicant volunteer/work for your organization?*

5. Did the applicant take on more responsibility or additional roles as timepassed?*

6. How did the applicant receive support and/or training?*

7. Why did the applicant resign?*

8. Did you know the applicant was applying to be a mentor?*

If so, what was your reaction?

9. What personal strengths do you feel the applicant has to offer?*

10. Based on your knowledge of who the applicant has in his/her life, to whom would he/she be most likely to turn, or be most responsive to, for support or guidance?*

11. Can the applicant be counted on to follow through on the commitments he/she undertakes?*

Please Explain:

12. To your knowledge, has the applicant ever had any trouble following rules?*

If so, what kind of rules?

13. Are you aware of any complaints being made or disciplinary actions being taken against the applicant?*

14. When have you witnessed the applicant interacting with children? How does the applicant interact with or relate to children?*

15. Have you ever known the applicant to be inappropriate (emotionally, physically, verbally, sexually) with either adults or children?*

If yes, please explain:

16. Would you recommend the applicant as a mentor for a child or youth?*

17. Is there anything you would like to add that would aid us in our decision?

By clicking this box:*

I understand and agree to the above statements.

Name*

Prénom Nom

Date*

Vulnerable Sector Reference

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Mentoring Programs