Form Nscadm 002 - Adult Leader Application Request For Reference - U.s. Navy League Cadet Corps

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ADULT LEADER APPLICATION
FOR OFFICIAL USE ONLY
U.S. NAVAL SEA CADET CORPS
U.S. NAVY LEAGUE CADET CORPS
REQUEST FOR REFERENCE
COMPLETE THIS FORM IN TRIPLICATE. ADULT VOLUNTEERS MUST PROVIDE THREE (3) REFERENCES AS PART OF THE APPLICATION PROCESS.
1. From
2. To (No Relatives)
COMMANDING OFFICER
Full Name
Street Address
UNIT NAME
City State Zip
3a. Applicant Name (Type or Print)
3b. Applicant’s Signature
3c. Date
The above named applicant has volunteered to become an adult leader in the Naval Sea Cadet Corps (NSCC). The
information you provide will be appreciated since it will be used to determine the applicant's suitability to work with youth.
The NSCC is a federally chartered youth program for ages 11-17 that is sponsored by the Navy League of the United
States and supported by the Department of the Navy and U.S. Coast Guard. An NSCC adult leader must be of high
moral character, intelligent, responsible, and mature.
Your statements will not be shared with the applicant at any time. Also, you will not be considered personally or legally
responsible should the applicant not be accepted, so please be as frank in your opinions as possible.
Your answering of this request is very important, so please complete and return it as soon as possible. For your
convenience a postage paid envelope has been enclosed. Your cooperation is appreciated.
4. QUESTIONNAIRE
4a. How long have you known the applicant?
4b. What is your relationship to the applicant? (No Relatives)
4c. Do you consider the applicant to be a responsible and reliable person?
YES
NO, if NO please explain:
4d. To the best of your knowledge, has the applicant ever been convicted of a criminal act or had his/her driver’s license revoked?
YES
NO, if YES please explain:
4e. Have you ever observed the applicant working with children?
YES
NO, if YES, in what capacity:
4f. Do you recommend the applicant to be entrusted with the supervision, guidance, and care of youth?
YES
NO, if NO please explain:
4g. Do you recommend this applicant to be accepted as an adult leader?
YES
NO
5. ENDORSEMENT
By signing you certify that to the best of your knowledge all of the information provided on this form is truthful and accurate.
5a. Full Name (Print or Type)
5b. Signature
5c. Date
PREVIOUS EDITIONS ARE OBSOLETE
Formerly NSCADM 005
NSCADM 002 (REV 08/14), Page 4

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