B You Practicum Reference Form

About You

Your Name:(Required)

First and Last

Your Business/Organization's Name (if applicable):

Your Phone Number:(Required)

Your Email Address:

Name of person reference is being provided for:(Required)

First and Last

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

Please specify if the applicant has worked with one or more of the following vulnerable populations within your business/organization:

What is/was the role of the applicant with your business/organization?

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

Does/did the applicant report directly to you?

How long did the applicant work or volunteer with your business/organization??

Did the applicant take on more responsibility or additional roles as time passed?

If yes, please explain how they took on more responsibility

How did the applicant receive support and/or training?

Why did the applicant resign? (if applicable)

Did you know the applicant was applying to become a mentor and what is your reaction to the idea?

How was the applicant's overall work ethic with you?

Did you face any challenges working with the applicant?

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

How did this applicant manage a large workload or sudden changes?

Based on your knowledge of them, who do you think the applicant would turn to for support and/or guidance?

How was this applicant's ability to lead/work with a team?

How was the applicant's attendance and punctuality?

Can the applicant be counted on to follow through on commitments?

When you have witnessed the applicant interacting with children, how do they interact and/or relate to them?

When you have witnessed the applicant interacting with another vulnerable population, please specify the population and comment on the interactions:

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

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

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

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

Phone

This field is for validation purposes and should be left unchanged.