Reference Check Form

Dear Referee: Given the sensitive and confidential nature of the work that we do at Bissell Centre, it is imperative that all candidates interested in volunteering or completing their practicum here are screened through a process that includes verifiable reference checks. As such, we ask that you please take a few minutes of your time to complete this form. Please be sure to include any additional comments that you believe would be of benefit to us determining a candidate's suitability. Thank you.

Please provide the full name of the applicant for whom you are providing this reference.

Please check each item at the point of scale which best indicate your rating of this individual.

Please check each item at the point of scale which best indicate your rating of this individual.

Please check each item at the point of scale which best indicate your rating of this individual.

Please check each item at the point of scale which best indicate your rating of this individual.

Please fill out this section with your information