A program of Bellefaire Jewish Children's Bureau, 22001 Fairmount Boulevard, Shaker Heights, OH 44118   



Reference Questionnaire Form
  
Please complete the required fields.* 
CONTACT INFORMATION
    
Reference Name: *                       Applicant Name: *  
             

Title:

Relationship: *   
   
       
  Phone Number:
  		 
 

- - ext   

     
 
 
 
 

  Please answer the following questions and submit the complete questionnaire form.
 

1. How long have you known the applicant?

 2. In what capacity?

 3. How does he/she relate with people on a personal level?

 4. Applicant's ability to accept supervision.

 5. Describe applicant's temperament and personality.

 6. Areas of strength.

 7. Areas of possible weakness.

 8. Ability to deal with conflict.

 9. Applicant's ability to relate with children.

10. Would you recommend this applicant as a "Big" for a child close to you?

11. Please comment on applicant's stability, consistency and responsibility.

12. Is there any reason why this person should not be accepted as a volunteer to JBBBSA?

 If yes, please explain why.

 
 
  
Please complete the following information.
EMPLOYERS/SUPERVISORS ONLY
 

3. How well does the applicant relate to his/her co-workers?

14. How reliable is the applicant in completing assignments?

15. In your opinion, what role does the applicant's career play in his/her life?
 
 
 
 
 
  Please list any additional comments below.  
ADDITIONAL COMMENTS
 

Please send me information on how I can become a Big Brother or Big sister. You may also
      complete an online volunteer application to initiate the process of volunteering.
                My address is:
               

 
 
 

Press the Submit Application form once your application and all the required fields have been completed.