Volunteer Services Reference Check

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St.

Marys Hospital Center

Volunteer Services Reference Check

Date:___________ Name of applicant:______________________

Name of referee:_________________________________________________________

How do you know the applicant:_____________________________________________

How long have you known the applicant:______________________________________

Describe the applicant overall personality:____________________________________


_______________________________________________________________________
_______________________________________________________________________

Is the candidate:
Dependable _____ Able to interact with others ______
Committed ______ Able to work independently ______
Suitable ______ Good communication skills ______

Are there types of patients the applicant might be unhappy working with:______________
_________________________________________________________________________

Does the applicant have any particular qualities that might hinder a successful experience:__
__________________________________________________________________________

Do you recommend him/her for volunteer work at our Hospital:_______________________


__________________________________________________________________________

Would you be comfortable leaving a frail member of your family in his/her care:
__________________________________________________________________________

Is there anything you would like to add:__________________________________________


__________________________________________________________________________

Reference checked by:____________________________ Signature:___________________

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