Reference Inquiry Form

Please complete this form based on your involvement with the applicant. They have applied to work part-time or volunteer with Extend-A-Family Waterloo Region. We offer a variety of programs where support is provided by the applicant to someone with a disability.

Reference form for:*

Please indicate which position the applicant has applied for:*

Employment
Volunteer

How long have you known the applicant?

In what context have you known the applicant?

Please list the applicant's strengths that would be valuable in their role supporting a person with a disability.

Please comment specifically on the following in regards to the applicant:

a) Ability to deal with stress or conflict:

b) Communication skills (e.g. written, verbal, etc.):

c) Compassion/empathy for others:

d) Relationships with others:

e) Community involvement:

f) Reliability and responsibility:

g) Ability to work independently and to take initiative:

Please indicate any areas that need strengthening and/or any concerns you may have about the applicant supporting people with disabilities.

Your information

Please complete the following information about yourself.

Your Name*

First Last

Your Occupation and Employer*

Your Email*

Your Phone Number*

Date of reference submission

Name

This field is for validation purposes and should be left unchanged.