Reference Request Form

Name of Applicant(Required)

First Last

Name of Reference(Required)

First Last

Phone(Required)

Email(Required)

Mailing Address(Required)

In What Capacity Do You Know the Applicant?(Required)

Relationships

Peer Relationships(Required)

Average

Awkward

Makes Friends Easily

Strong Friendships

Loner/Avoids Social Relationships

Good Reputation

Poor Reputation

Respects Others

Disrespectful

Sensitive/Considerate

Insensitive

Patient

Quick Tempered

Family Relationships(Required)

Healthy/Supportive

Healthy/Not Supportive

Unhealthy/Supportive

Unhealthy/Not Supportive

Unknown

Self-Concept(Required)

Confident

Arrogant

Average

Secure

Insecure

Self-Starter

Needs Encouragement

Character(Required)

(1 =surface, 10 =very well)

Working Relationship(Required)

Works well with others

Has average ability to work with others

Sometimes has difficulty interacting with others

Has problems relating to fellow workers

Responds to stress/pressure(Required)

Copes Well

Adapts slowly

Dominates situation

Withdraws socially or emotionally

Becomes overly critical of others

Overreacts

When faced with conflict, this person generally responds(Required)

(choose all that apply)

Openness to resolving conflict

Peacemaking

Slow to Anger

Confrontation

Defensive/Critical Attitude

Gossips

Lack of Cooperation

Withdrawal/Avoidance

Related to Authority(Required)

Able to take direction

Does not listen well

Cooperative

Questions authority

Team player

Likes to do their own thing

Respectful of authority

Disrespects authority

Relates well to adults

Sometimes has trouble interacting with adults

Easily confused

Supervisory Needs(Required)

Needs little close supervision, only direction

Does well with regular, routine supervision

Needs accountability and encouragement to accomplish tasks/goals

Needs excessive supervision

Spiritual Maturity/Knowledge

Knowledge of the Bible(Required)

Able to teach others

Regularly studies the Bible

Rarely studies the Bible

Unknown

Stage of Spiritual Growth(Required)

Spiritually mature

Growing believer

New believer

Spiritually inconsistent

Unknown

Involvement in discipleship(Required)

(choose all that apply)

Currently discipling others

Currently being discipled

Not in a discipling relationship

Able to disciple others

Unknown

Level of equipping to share the Gospel(Required)

Equipped to share the Gospel

Needs additional training to share the Gospel

Unequipped to share the Gospel

Unknown

Practice of sharing the Gospel(Required)

(choose all that apply)

Consistently verbally shares the Gospel

Inconsistently shares the Gospel

Rarely/Never shares the Gospel

Unknown

Applicant’s involvement in a local church(Required)

Very involved

Rare involvement

Occasionally involved

Not actively involved

Unknown

Skills

Communication Skills(Required)

Excellent communicator

Average communicator

Struggles to communicate with others

Over communicates

Based on your knowledge of the applicant, what skills and gifts do they possess that are helpful in ministry?(Required)

Where does the applicant excel? Where does he/she need to grow? Is there other information you think we need to know about the applicant?(Required)

The Alabama Baptist State Board of Missions upholds the highest standards for people serving with and through our organization. To your knowledge, has the applicant ever been accused of, engaged in, or shared with you about any inappropriate conduct with another person—be it a minor or other adult? (Inappropriate conduct includes but is not limited to, threatening behavior, verbal or sexual harassment, unwanted advances, things such as real or virtual sexual activity, or hate speech?(Required)

Yes

If yes, please explain.

To your knowledge, is there anything in the applicant’s past or present that would hinder their involvement in church related ministry or missions involvement?(Required)

Phone

This field is for validation purposes and should be left unchanged.

Deadline May 15