Reference For Volunteer Candidate Form
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2Reference For Volunteer Candidate
The person named below has expressed an interest in a Girl Scout volunteer position. You have been
suggested as someone who knows the candidate’s qualifications for the position. On the bottom of this sheet
please give an evaluation of the candidate.
Please return the completed form to Karin Jensen-Mirabile, Mail: 442 Moreland Rd., Commack, NY 11725
Email: kjensen@gssc.us • Fax: 631-543-9005
Evaluation
Candidate’s Name:_________________________________________________________________________SU #:_____________
Address:_______________________________________________City:_________________________ State:_____ Zip:_________
Position Applied For: _____________________________________________ School:____________________________________
Reference’s Name:___________________________________________ Occupation:____________________________________
Address:_______________________________________________City:_________________________ State:_____ Zip:_________
Phone:_______________________________ Email:_________________________________________________________________
Relation to Candidate:____________________________________________
Check all appropriate boxes and include a brief statement as necessary
Interaction with Children
1. I have observed the candidate’s interaction with children - � Yes � No
2. The candidate works well with children -
� All Ages � Ages 5-7 � Ages 8-10 � Ages 11-15 � Ages 16-18 � Should not work with children
3. The candidate has an understanding of the needs and interests of children and can stimulate their enthusiasm -
� Always � Usually �Occasionally � Seldom � Never
4. The candidate is warm and caring with children and demonstrates concern for their health and safety -
� Always � Usually �Occasionally � Seldom � Never
5. The candidate has demonstrated that she/he can show sensitivity to and behave appropriately with children
from ethnic, religious and/or racial groups different from her/his own -
� Always � Usually �Occasionally � Seldom � Never
6. Please provide a brief statement as to the candidate’s abilities or limitations in working with children -
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Girl Scouts of Suffolk County • 442 Moreland Road, Commack, NY 11725 • (631) 543-6622 • gssc.us
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