Volunteer Services Reference Form
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1
2Long-Term Care
VO-0401-00
Appendix C
Homes & Services
Volunteer Services Reference Form
An employer/previous Volunteer Supervisor, a teacher, coach, clergy, physician, landlord or
someone who knows you well should provide a reference. Family members or friends may not
provide a reference.
The following, ______________________ has applied to volunteer at ________________________.
(Prospective volunteer)
(Name of Home or Community Program)
As a volunteer, this individual would have contact with residents/clients who are vulnerable, recovering
from illness and have special needs. Volunteers assist staff, residents/clients and their families in a
variety of ways. Activities might include visiting, offering support and comfort, working in positions of
trust and confidentiality.
Volunteers are also required to work co-operatively with staff and other
volunteers.
Please put completed form in envelope provided, seal and return to applicant.
Referee Information:
Name of Referee:
Organization:
Title Position:
Address:
Phone #:
E-mail:
Date:
Signature of Referee:
Qualities/Strengths:
1.
How long have you known the applicant:
2.
In what capacity have you known the applicant :
3.
In your opinion, is the applicant:
(please select)
reliable
responsible
organized
respected
friendly
caring
Other Comments:
4.
Which of the following strengths or qualities does this individual possess that would be of
value in performing volunteer duties:
(please select)
Ability to follow instructions
Takes initiative
Shows sound judgment
Other Comments:
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Parent category: Life