Lake Brownwood Christian Retreat



9030 Retreat Road Brownwood, Texas 76801

(325) 784-5133

lbcr@

Applicant Reference Form

Please complete the following questions to the best of your ability and provide as much information as possible.

Candidate name ____________________________________ Years known _________

Your name ________________________________________ Phone # _______________________

1. What is your relationship to the applicant?

____Employer or Supervisor ____Pastor ____Teacher ____Roommate

2. In What Situations Have You Observed the Applicant?

____Home ____Work ____School ____Social ____Church ____Other

3. What can you tell us about this applicant?

4. What could we do to aid in the applicant's personal development?

5. Give your personal impression of the applicant's spiritual life (devotions, prayer, witness etc.).

6. Has the applicant proven on any occasion to be unreliable, dishonest, or of questionable character?

Character

Please rate the applicant on a scale of 1-5 with one being the worst and 5 being the best

Dependable ____ Fair ____ Optimistic ____ Kind ____ Encouraging ____ Humble ____

Helpful ____ Lazy ____ Dishonest ____ Vulgar ____ Adaptable ____ Compassionate ____ Energetic

Efficient ____ Extraordinary ____ Flexible ____ Honest ____ Independent ____ Mature ____ Reliable ____

Personal

Please rate the applicant on a scale of 1-5 with one being the worst and 5 being the best

Personal appearance ____ Receives constructive criticism ____ Christian Character ____

Concern for others ____ Social Skills ____ Integrity ____ Decision making ____ Ability to follow ____

Work etchic

Please place an X next to the appropriate category

Team player: Often ____ Seldom ____Sometimes ____ Never ____ Not Observed ____

Works well with others as part of a team: Often ____ Seldom ____ Sometimes ____ Never Not Observed ____

Observance of deadlines: Often ____ Seldom ____ Sometimes ____ Never Not Observed ____

Ability to take initiative: Often ____ Seldom ____ Sometimes ____ Never Not Observed ____

Punctuality: Often ____ Seldom ____ Sometimes ____ Never ____ Not Observed ____

Reference forms may be mailed to:

Attn: Executive Director

9030 Retreat Road

Brownwood, TX 76801

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