Interview Checklist/reference Check Report Template
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1
2Society of Saint Vincent de Paul
•
Société de Saint-Vincent de Paul
National Council of Canada
•
Conseil national du Canada
9.10
INTERVIEW CHECKLIST/REFERENCE CHECK REPORT
Complete this checklist after the interview, not in the presence of the applicant. Fill it out from notes made during
meeting. It will help you, the interviewer, remember the discussions and make the decision-making process easier.
Sample questions on reverse of this page.
Applicant’s Name:______________________________
Date of Interview________________________
Commits to active expression of The Mission and Values of the Society:
Yes__ No__ Unknown__
1.
Commits to personal spiritual development
Yes__ No__ Unknown__
2.
Commits to following the Society’s Rule, policies and procedures
Yes__ No__ Unknown__
3.
Commits to being a positive role model and accountable for own actions
Yes__ No__ Unknown__
4.
Commits to acquiring the knowledge and skills appropriate to his or her role
Yes__ No__ Unknown__
5.
Commits to signing Service Covenant/Confidentiality Agreement
Yes__ No__ Unknown__
6.
Reference Check Report (Each reference given on the application form must be contacted and checked)
# 1 Name____________________ Contact Date:________________ Contacted By:________________________
How long have you known the applicant? ____________________
Your relationship to the applicant: _________________________
Understanding the nature of the Society’s work, are you willing to recommend the applicant for membership in the
SSVP?
Yes___ No___ Uncertain________ Are there any causes for concern?
Comments: (if uncertain/cause for concern):
# 2 Name____________________ Contact Date:________________ Contacted By:________________________
How long have you known the applicant? ____________________
Your relationship to the applicant: _________________________
Understanding the nature of the Society’s work, are you willing to recommend the applicant for membership in the
SSVP?
Yes___ No___ Uncertain________ Are there any causes for concern?
Comments: (if uncertain/cause for concern):
# 3 Name____________________ Contact Date:________________ Contacted By:________________________
How long have you known the applicant? ____________________
Your relationship to the applicant: _________________________
Understanding the nature of the Society’s work, are you willing to recommend the applicant for membership in the
SSVP?
Yes___ No___ Uncertain________ Are there any causes for concern?
Comments: (if uncertain/cause for concern):
Screening – Interview Checklist/Reference Check Report (9.10)
Orig. 2005; Rev. 04/2007
P1/2
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