Reference Forms

Lonehollow P.O. Box 700 Utopia, Texas 78884 (830)966-6600 * 210-579-7091 Fax

The following information will not be shared with applicant and will be kept confidential.
Please note! Tab through the following fields, do not press enter, pressing enter will send the form prematurely. Thanks!

Name of applicant you are providing a reference for

We are providing this form targeting specific areas that apply to the uniqueness of this position. We greatly appreciate your completion of this confidential evaluation.

Personality / Character Traits

Excellent

Good

Fair

Poor

No Comment

Ability to work with children

Maturity

Confidence

Enthusiasm

Leadership

Responsible

Honest

Dependable

Organized

Initiative

Cooperative

Compatible

Attitude

Appearance

Health

Would you place your child in the care of this person?
How long have you known this applicant?
In what capacity have you known this applicant?
Do you know of any reason why applicant should not be considered for this position?
Remarks:

Your Name
Address
City State Zip-code
Phone# Alternate Phone#

By initialing below I agree that the information provided above is accurate and correct
Initals Date