Referral Form
Referrer Information
Name
*
First Name
Last Name
Date you filled out the reference
*
-
Day
-
Month
Year
Date
E-mail
Phone Number
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Area Code
Phone Number
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Referral Information
Name of person for whom you are filling out the referral.
*
First Name
Last 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.
*
Yes
No
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
*
Excellent
Very Good
Good
Fair
Poor
Maturity
*
Excellent
Very Good
Good
Fair
Poor
Self Motivation
*
Excellent
Very Good
Good
Fair
Poor
Motivating Others
*
Excellent
Very Good
Good
Fair
Poor
Energy
*
Excellent
Very Good
Good
Fair
Poor
Trustworthiness
*
Excellent
Very Good
Good
Fair
Poor
Reliablity
*
Excellent
Very Good
Good
Fair
Poor
Team Work
*
Excellent
Very Good
Good
Fair
Poor
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
*
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.
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