(Will need three copies of this form.)
LEADER REFERENCE FORM 2013-2016 Oklahoma Indian Missionary Conference Applicant’s Name: ______________________________________________ City___________________________________________ The above named individual has applied to work with children and/or youth within our conference. Please honestly complete this form as it relates to this person and his/her characteristics and qualifications to work in such settings. Return the completed form to:
Oklahoma Indian Missionary Conference 3020 S. Harvey St. Oklahoma City, OK 73109 How long have you known the applicant? _______ In what capacity? ____________________________________________________________ Please rate this individual in the following areas: Excellent Personal Habits Moral Character Compassion Responsibility Emotional Stability Christian Maturity Openness to Critique Teamwork Ability Health
1 1 1 1 1 1 1 1 1
Good Average Poor 2 2 2 2 2 2 2 2 2
3 3 3 3 3 3 3 3 3
4 4 4 4 4 4 4 4 4
Do Not Know* ____ ____ ____ ____ ____ ____ ____ ____ ____
Comments or *explanations (Use back if needed): Signature _________________________________________________Date __________ Please Print Your Name and address on back
(Please Print Your Name and address) Name
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Address
________________________________________________ ________________________________________________ ________________________________________________
Phone
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Comments or Explanations: