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Reference Form

This document is a reference form for a volunteer applicant at Botsford Hospital. It asks a non-family reference to evaluate the applicant's ability to interact with others in a hospital setting based on traits like respect, courtesy, teamwork, professionalism and safety. The reference is asked to characterize their relationship with the applicant, how well they know them, and how the applicant interacts with people of different cultures or backgrounds. The reference is also asked if they have seen the applicant interact with children or elderly adults, and if they are aware of any reason the applicant may not be an effective volunteer. Finally, the reference is asked to provide an overall recommendation for the applicant.

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mememe123123
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27 views

Reference Form

This document is a reference form for a volunteer applicant at Botsford Hospital. It asks a non-family reference to evaluate the applicant's ability to interact with others in a hospital setting based on traits like respect, courtesy, teamwork, professionalism and safety. The reference is asked to characterize their relationship with the applicant, how well they know them, and how the applicant interacts with people of different cultures or backgrounds. The reference is also asked if they have seen the applicant interact with children or elderly adults, and if they are aware of any reason the applicant may not be an effective volunteer. Finally, the reference is asked to provide an overall recommendation for the applicant.

Uploaded by

mememe123123
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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Volunteer Services Department

REFERENCE FORM
(To be completed by an adult who is a non family member)
Volunteer Applicant Name:

The person named above has applied for a volunteer position within Botsford Hospital. The hospital offers a variety
of volunteer opportunities that involve our five Service Standards (Positive First Impressions, Respect & Courtesy,
Teamwork, Professionalism & Safety). It would be of great assistance to us if you would carefully answer the
following questions to the best of your knowledge and return this form to our office as soon as possible.
The information you provide will be held in the strictest confidence.

1. How do you know the applicant or in what capacity have you known the applicant?
_________________________________________________________________________________________
_________________________________________________________________________________________

2. How long have you known the applicant? _______________________________________________________

3. How well do you know the applicant?


Very Well
Well

Average

Little

Very Little

4. How does the applicant approach people with cultures or lifestyles different from their own?
Open mindedness
Curiosity
Acceptance
Caution
Judgment
Other (please explain) ______________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________

5. Have you had a chance to see the applicant with children of any age and/or elderly adults? If yes, how would
you characterize their ability to interact with children and/or elderly adults?
Friendly
Understanding

Well-liked
Engaging

Impatient
Creative

Inconsistent

Flexible

Caring

Dependable

Other (please explain) ______________________________________________________________________


________________________________________________________________________________________
________________________________________________________________________________________

Volunteer Applicant Name:

6. Are you aware of anything that would prevent the applicant from being an effective volunteer?
If yes, please explain.
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

7. Keeping in mind the importance of commitment, reliability, stability and good judgment, what overall
recommendation do you give this applicant?
My highest recommendation
I recommend
I recommend with reservations (please specify below)
I cannot recommend this person to your program (please specify below)
Comments: ________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Your Printed Name:_____________________________________________________________________________


Address:

________________________________________________________________________________
________________________________________________________________________________

Telephone:

________________________________________________________________________________

Signature:

________________________________________________________________________________

Return form via US mail or fax to:

BOTSFORD HOSPITAL VOLUNTEER SERVICES


28050 Grand River Avenue
Farmington Hills, MI 48336-5933
Office: (248) 471-8082

Fax: (248) 615-7211

03-12-14

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