Reference form

The applicant below is a candidate for a Representative position with Terra Lingua USA. The duties of this position entail:
- Promoting cultural exchange programs to teachers, students, and the public.
- Finding and screening American host families for international students.
- Making quality presentations to school language classes and/or community groups.
- Recruiting and mentoring a team of area representatives.

We appreciate your completion of this form. Your honest appraisal is very important to assure the selection of capable Representatives. As the sincerity of your opinions is indispensable, your comments will be kept in strict confidence.

Applicant Information

First Name: *

Last Name: *

Middle Name: *

Reference Information

First Name *

Last Name *

Middle Name: *

Phone Number *

Address *

City *

Address Line 2

State *

Zip Code *

Email Address *

Date completed *

Comments

What is your relationship to the applicant? *

How long have you known the applicant? *

To the best of your knowledge, is the applicant conscientious in following through on responsibilities? *

Yes

No

How capable would the applicant

be in making presentations?

*

How well does the applicant relate

to other adults and young people?

*

Please comment on the applicant’s:

Organizational skills:

Communication skills:

Assertiveness:

Is there any reason why you might hesitate in recommending this applicant for this position. Please, explain here: *

Any other comments you’d like to add for this applicant? *

Due to the responsibilities of this position we are required to follow up with a brief phone call. Please offer the best day/time to reach you.

Please type in your full name as a signature: *

Date: *

For staff use only (please do not type in fields below)

Reference Checked by

Date of call:

Manager Signature: