Diocese of Algoma

Youth Synod Reference Check Form

NOTE: This form to be kept confidential to: The Bishop of Algoma, The Executive Archdeacons, The Program and Youth Consultant, and, if further consultation is required, the Deanery Youth Coordinator from the applicant’s deanery.

Note to Interviewer(s): At the beginning of the interview, assure the referee that their responses will be kept confidential to the above parties, and that the applicant will not be told or otherwise informed about any aspect of this conversation. Encourage them to be candid.

Name of Applicant:______________________________________

Parish/Church Affiliation:________________________________________________

Name of Reference:_____________________________________________________

Phone #:__________________________ Address:_____________________________

Relationship to Applicant:________________________________________________

Interview Conducted by: ____________________________ On: _______________________

Questions:

1. How long have you known the applicant? _______________________________________

2. Have you seen him/her interact with teenagers? If so, what are your impressions of his/her relationship with youth? ________________________________________________________

____________________________________________________________________________

3. The applicant has expressed interest in being/doing ______________________ at Youth Synod. What strengths do you think he/she would bring to that role?

_____________________________________________________________________________

4. Does this person work well within a leadership team? _______________________________

5. How does this person handle frustration or anger?___________________________________

______________________________________________________________________________

6. Is there any persistent, irresponsible behaviour you have observed that would make this person a negative role-model for young people? _______________________________________

______________________________________________________________________________

7. Would you have any concerns about inviting this person to be a leader at Youth Synod? ____

_____________________________________________________________________________