Employer Reference

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

If so, what was your reaction?

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

5. 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?*

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

Please Explain:

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

If so, what kind of rules?

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

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

10. 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*

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Date*

Phone

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