Fillable Volunteer Reference Form - Holland Bloorview printable pdf download

Volunteer Reference Form - Holland Bloorview

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Volunteer Reference Form

For: ________________________

Volunteer Resources would appreciate your assistance in providing us with a reference on

behalf of the above individual, who has applied to volunteer their services.

To be completed by an employer, supervisor, teacher or individual who has known

the applicant in a professional capacity

All information provided is CONFIDENTIAL.

Name:

Job Title:

Organization:

Phone #:

E-mail (For reference contact purposes only):

__:__

to __:__

Best to reach me:

S/S

How long have you known this applicant? _______ In what capacity?__________________

(i.e. employer, supervisor, teacher)

I know the applicant:

very well

well

casually

Please rate the following, on a scale of 1-5:

5 being Excellent - 1 being Poor – NA for unable to comment

Commitment,

Interactions with

Reliability &

authorities

clients/customers

Punctuality

Initiative

Attitude

Ability to Communicate

Interactions with

Compassion

Interactions with peers

children

Adaptability

Interactions with persons with disabilities

This person’s greatest strength is:

What is this person’s area for improvement:

Holland Bloorview Kids Rehabilitation Hospital serves children and young adults with

disabilities or complex long-term needs and their families. How well do you believe this

person would work with children who have special needs?

Would you consider hiring/rehiring this person?

Yes

Would you entrust the care of your own children and/or children you’ve been entrusted the

care of to this applicant?

Yes

Other comments:

I understand that any willful misrepresentation made by me in connection with this

reference will be sufficient cause for the dismissal of the applicant from Volunteer Resources.

Signature:

Date:

Holland Bloorview could not realize its mission and vision without volunteers.

Thank you for taking the time to provide this reference.

Office Use Only:

Reference Contacted – Date_____________ Initials ________

Volunteer Reference Form - Holland Bloorview

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