YMCA Reference Check

Dear Reference,

The applicant who has listed you as a reference is applying for a position with the YMCA of Niagara.

The applicant, if selected, will be working directly with children and youth, and is required to be positive role model. They will need to work in a group environment, communicate clearly with others, participate in activities, and follow safety guidelines to ensure a positive experience for participants.

Please complete this form to the best of your knowledge; it will help us make the best possible decision concerning the applicant. Your candid assessment of his/her suitability for working with children and youth is essential.  All references are strictly confidential; we do not share them with the applicant.

If we require any additional information or have questions about your responses, we will reach out to you at the phone number you provide below.

Thank you for taking the time to be a reference!

Applicant's name *

First

Last

To which team/position is the applicant applying? *

Aquatics
Child and Youth
Day Camp
Community Outreach

Reference's name *

First

Last

Reference's title/position *

Contact number *

Contact e-mail *

How long have you known the applicant? Please describe your working relationship.

What were the applicant’s primary responsibilities in this role? Why did they leave this role (if former)?

What would you describe as the applicant’s key strengths?

What would you describe as an area for further development?

Please rate the applicant’s ability to:

	Very poor	Below average	Average	Good	Excellent
Demonstrate concern for health and safety	Very poorDemonstrate concern for health and safety Very poor	Below averageDemonstrate concern for health and safety Below average	AverageDemonstrate concern for health and safety Average	GoodDemonstrate concern for health and safety Good	ExcellentDemonstrate concern for health and safety Excellent
Their ability to problem solve and deal with challenging situations	Very poorTheir ability to problem solve and deal with challenging situations Very poor	Below averageTheir ability to problem solve and deal with challenging situations Below average	AverageTheir ability to problem solve and deal with challenging situations Average	GoodTheir ability to problem solve and deal with challenging situations Good	ExcellentTheir ability to problem solve and deal with challenging situations Excellent
Guide, motivate and inspire others	Very poorGuide, motivate and inspire others Very poor	Below averageGuide, motivate and inspire others Below average	AverageGuide, motivate and inspire others Average	GoodGuide, motivate and inspire others Good	ExcellentGuide, motivate and inspire others Excellent
Give direction to groups with various skills and talents	Very poorGive direction to groups with various skills and talents Very poor	Below averageGive direction to groups with various skills and talents Below average	AverageGive direction to groups with various skills and talents Average	GoodGive direction to groups with various skills and talents Good	ExcellentGive direction to groups with various skills and talents Excellent
Use appropriate judgement in unpredictable situations	Very poorUse appropriate judgement in unpredictable situations Very poor	Below averageUse appropriate judgement in unpredictable situations Below average	AverageUse appropriate judgement in unpredictable situations Average	GoodUse appropriate judgement in unpredictable situations Good	ExcellentUse appropriate judgement in unpredictable situations Excellent
Involve others in discussion, planning and implementing	Very poorInvolve others in discussion, planning and implementing Very poor	Below averageInvolve others in discussion, planning and implementing Below average	AverageInvolve others in discussion, planning and implementing Average	GoodInvolve others in discussion, planning and implementing Good	ExcellentInvolve others in discussion, planning and implementing Excellent
Act as a personal role model	Very poorAct as a personal role model Very poor	Below averageAct as a personal role model Below average	AverageAct as a personal role model Average	GoodAct as a personal role model Good	ExcellentAct as a personal role model Excellent
Share a leadership role with others	Very poorShare a leadership role with others Very poor	Below averageShare a leadership role with others Below average	AverageShare a leadership role with others Average	GoodShare a leadership role with others Good	ExcellentShare a leadership role with others Excellent
Be dependable and reliable	Very poorBe dependable and reliable Very poor	Below averageBe dependable and reliable Below average	AverageBe dependable and reliable Average	GoodBe dependable and reliable Good	ExcellentBe dependable and reliable Excellent
Relate to others (peers and customers) on the job	Very poorRelate to others (peers and customers) on the job Very poor	Below averageRelate to others (peers and customers) on the job Below average	AverageRelate to others (peers and customers) on the job Average	GoodRelate to others (peers and customers) on the job Good	ExcellentRelate to others (peers and customers) on the job Excellent

The YMCA has a Child Protection Policy in place. A responsibility of this position may require the applicant to have contact with children and/or vulnerable persons. Are you aware of any issues or incidents, or do you have any concerns related to the applicant being in contact with children and/or vulnerable persons?

Is there anything related to work performance or this individual you would additionally like to discuss and would you rehire them?

Acknowledgement *

The information I have provided in this online reference is accurate and reflective of the applicants skills to the best of my knowledge. I understand that the YMCA may contact me to verify the information provided.

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