Wessex Reference Checks
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2Rotary District: _____ Club: _____________________________________
WESSEX Reference Checks for: ___________________________
(Full Name)
Simply requesting references in the application is not sufficient. Contact each reference by phone or in person, and
ask the following standard set of questions. Verify that no more than one reference is a Rotarian and that none are
relatives. Record the date of the interview and responses to each question, and forward along with the Volunteer
Affidavit Form.
Reference #1: _________________________ Checked by: _______________________ Date: __________
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How long have you known this individual? In what capacity?
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How would you describe the applicant’s ability to work with and relate to other adults?
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How would you describe the applicant’s ability to work with and relate to young people?
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To the extent you know, please tell me about the applicant's roles with youth; for example, school volunteer,
youth coach, day care volunteer, youth group leader, etc.
•
Do you think this person is well qualified to work with youth?
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Have you observed the applicant working with youth, and if so, can you give me an example of how the applicant
relates to young people?
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If you have seen the applicant discipline a child, please describe what you saw.
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Would you have any reservations about recommending this person to serve as a Youth program volunteer?
Reference #2: _________________________ Checked by: _______________________ Date: ___________
•
How long have you known this individual? In what capacity?
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How would you describe the applicant’s ability to work with and relate to other adults?
•
How would you describe the applicant’s ability to work with and relate to young people?
DOCUMENT RETENTION & TRACKING INSTRUCTIONS: Appropriate District or Club Officer must upload a
digital copy to WESSEX online database. Records will be maintained for a minimum of three years.
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Rev 1 12/1/2010
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