Reference

Applicants Name:

The person named above has chosen you as a reference. He/she is applying, or at least considering, application with Heart To Heart International Ministries, a nonprofit Christian organization. This implies probable service in crosscultural and potentially stressful situations. Your honest appraisal in answering the following questions, including negative or weak areas, will help us as we guide and evaluate this person. This reference is confidential.


Please indicate the circumstances under which you know this person:

Long-Term Friendship

Dormmate/Roommate

Casual Acquaintance

Working Relationship

Member of Congregation

Teacher/Student

Other:

How long have you known this person:

The following phrases describe attitudes or personality characteristics. Please check the box under the heading which most closely represents how well the phrase describes the person. Please make comments where you believe it would benefit. Use the following definitions to guide your evaluation:

Strongly Agree:

Outstanding characteristic

Agree:

Normal characteristic

Undecided:

Cannot make a definitive statement

Disagree:

This behavior is not a good description of this person

Strongly Disagree:

This is clearly a problem area

General Life Attitudes

Strongly Agree

Agree

Undecided

Disagree

Strongly Disagree

Maintains a positive attitude in difficult circumstances.

Adapts well to new situations.

Is self-motivated without many external rewards.

Does not evidence ethnic, sexual, or other prejudices.

Is eager to grow and open to new ideas and ways of doing things.

Spends money wisely within own means.

Is responsible toward indebtedness.

Dresses modestly and appropriately.

Relationships

Is tactful.

Listens to and is sensitive to others.

Goes out of the way to be helpful.

Cooperates with others.

Willingly accepts direction, correction and advice.

Seeks advice when needed.

Is an effective team member.

Spiritual Maturity

Applies Biblical principles to his/her life.

Regularly fellowships with other Christians.

Willingly shares with others from personal experiences.

Supports others through prayer and encouragement.

Physical and Emotional Health

Has good health.

Has sufficient energy and stamina.

Has a balanced self esteem.

Is productive in stressful situations.

Is not tense or nervous.

Is not depressed or moody.

Is not fearful or anxious.

Is not irritable.

Work Qualities

Does accurate, thorough work.

Manages use of time well.

Shows perseverance to fulfill commitments.

Works well alone.

Is motivated to do best possible job.

Completes tasks according to instructions.

Is self-motivated.

Leadership and Teaching Abilities

Stands out as a leader.

Motivates other people.

Is trusted by others.

Oral communication is clear.

Written communication is clear.

Delegates responsibilities.

Makes sound decisions.

Does not procrastinate.

Able to teach others.

Summary Comments:

Your Full Name:

Address Line 1:

Address Line 2:

City:

State:

Postal Code:

E-Mail Address:

Area code & Telephone Number: