Referral Form

Referral Form
Referrer Information
Name*

First NameLast Name
Date you filled out the reference*

DayMonthYear
Date
E-mail
Phone Number

Area CodePhone Number

Referral Information
Name of person for whom you are filling out the referral. *

First NameLast Name
Would you have any concerns whatsoever about this applicant being in contact with children or young people. If yes we will contact you in confidence.*

YesNo
Note:

All information given will remain confidential, and only be shared if necessary on a ‘need to know’ basis, should the applicant be successful. Please be complete and honest in your evaluation of this person.
How long have you known this person? *
In what capacity have you known this person? *
How would you describe his/her personality?*
Your assessment of the applicant in the following
Responsibility*

ExcellentVery GoodGoodFairPoor
Maturity*

ExcellentVery GoodGoodFairPoor
Self Motivation*

ExcellentVery GoodGoodFairPoor
Motivating Others*

ExcellentVery GoodGoodFairPoor
Energy*

ExcellentVery GoodGoodFairPoor
Trustworthiness*

ExcellentVery GoodGoodFairPoor
Reliablity*

ExcellentVery GoodGoodFairPoor
Team Work*

ExcellentVery GoodGoodFairPoor
In as far as you know the applicant, what would you describe as their key strengths?*
In as far as you know the applicant, what would you describe as their key weaknesses?*
In your opinion, is the applicant a suitable children/teen camp volunteer?*
Is there any other information about the applicant that you think we should know about?*
Signature*

Clear
GDPR:

BCM Ireland is committed to keeping all Information/Data held on all personnel involved with us in accordance with the General Data Protection Regulations. All concerned have the right to ask for and see what information we have held on them.
BCM is a registered charity as CHY 8203 and Registered Charity Number (RCN) 20019778.
Should be Empty:

Referral Form

Referrer Information

Referral Information

Note:

Your assessment of the applicant in the following

GDPR: