Reference Response Information

Emergency Response Team Volunteers

Please enter name of the Emergency Response Team applicant(Required)

First Name Last Name

The individual named above has expressed an interest in serving on the Emergency Response Team for our church. The Emergency Response Team volunteers are responsible for providing protection and security for people attending church services and special events at Parkhills, and/or assisting in emergencies such as medical, fire, or natural disaster. The candidate has listed you as a reference. In order for Parkhills Baptist Church to properly evaluate the qualifications of this candidate, we are asking you to complete this form with your honest opinions and impressions of the candidate. Your response to all questions will be kept confidential.

How long have you known the applicant?(Required)

In what capacity have you known the applicant? (i.e. co-worker, friend, neighbor)(Required)

Are you aware of anything in the candidate's background, personality, or behavior that could in any way negatively affect the applicant's ability to serve on the Emergency Response Team?(Required)

Yes

If yes, please explain(Required)

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

Yes

If yes, please explain(Required)

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

Yes

If yes, please explain(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)

Enter Your Name(Required)

First Name Last Name

Date(Required)