Reference Check Form

Volunteer/Student Reference Check (CONFIDENTIAL)
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.
Applicant
Please provide the full name of the applicant for whom you are providing this reference.
Name*
First Last
Relationship
What is the nature of your relationship to the applicant?*
- Personal
- Business
- Academic
How well would you say you know the applicant?*
- Well Known
- Moderately Known
- Somewhat Known
How long have you know the applicant in months/years?*

Do you have any concerns, questions, or reservations with regard to the applicant as a volunteer or completing their practicum at Bissell Centre?
If you are/were in a capacity to hire this individual to work with you, would you do so?
Is there anything else you would like to share with regard to the applicant?*

Volunteer/Student Reference Check (CONFIDENTIAL)