ERT Reference Response Information

Please complete this form to the best of your knowledge of the candidate who applies to the Emergency Response Team at Parkhills Baptist Church

Your Name(Required)

First Last

Please enter the name of the applicant(Required)

First Last

Email(Required)

Enter Email Confirm Email

How long have you known the applicant?(Required)

Years and Months

In what capacity have you know the applicant?(Required)

(i.e co-worker, friend, neighbor)

Are you aware of anything in the candidates background, personally, or behavior that could affect the applicants ability to serve on the Emergency Response Team?(Required)

Are you aware of any event in which the candidate displayed an inability to control anger or handle weapons appropriately?(Required)

From your knowledge of this person, is there anything from their past that would disqualify them from working iwth minors or senior adults?(Required)

The above information is true and correct to the best of my knowledge. I acknowledge that my electronic signature is the legal equivalent of my manual signature on this form.(Required)

Yes

Enter your name

First Last

Signature