Name of Applicant. has volunteered to work with children and/or youth within the ministry of Grove Bible Church. There has been no accusation of any misconduct and there is no reason to suspect misconduct. For the protection of our children and ministries, however, please provide verification of this individual’s character and suitability for service.

1. How long have you known this person and what is your relationship to them? Type Answer Here.

2. In what capacity have you observed this person work with children/youth before? Type Answer Here.

3. What do you consider this person’s strengths to be, especially in regards to working with children/youth? Type Answer Here.

4. What concerns, if any, do you have about this person’s behavior or mannerisms in relating to children/youth? Type Answer Here.

5. Are you aware of this person having been convicted or pleading guilty to any criminal offense against children/youth or otherwise? Y	N If yes, please explain:

Type Answer Here.

6. Can you recommend this person without hesitation to work with children or teens? Y	N If no, please explain: Type Answer Here.

Name (please print): Type Full Name. Date: Click or tap to enter a date.

Signature: Type Full Name to Sign.

Address: Address, City, State, Zip Code.

Phone: (555)555-5555. Email: youremail@email.com

Please return this reference sealed in the enclosed envelope to: Grove Bible Church, 6990 E. Price Rd., St. Johns, MI 48879. For confidentiality, please do not return this form to the applicant.