Belleville AmeriCorps Applicant Reference Form

  • Reference Information

  • Form Completion Options

    Serving as an AmeriCorps member involves a significant commitment and many challenges. Therefore, we would appreciate your honest appraisal of the applicant's qualifications to serve. Although you may know the applicant in only one capacity, such as supervisor or teacher, please try to respond to each section.
    Regardless of the option you choose, please complete this form within seven (7) days. The evaluation process cannot be initiated until the applicant returns the reference form to the Belleville AmeriCorps office. After completing the reference form, please submit it with the "Submit" Button at the bottom.
  • I am (was) the Applicant's

  • Job SupervisorCompanyStart DateEnd Date
  • Volunteer SupervisorOrganizationStart DateEnd Date
  • Co-workerCompanyStart DateEnd Date
  • EmployeeCompanyStart DateEnd Date
  • TeacherSchoolStart DateEnd Date
  • OtherCompany/OrganizationStart DateEnd Date
  • Section I: Motivation and Commitment

    An applicant's personality and life goals should be consistent with volunteer service under challenging conditions. Applicant should be willing to give of themselves. They should not have rigid or overly high expectations about service, and joining AmeriCorps should relate to their past experiences and future plans.
  • Section II: Work Skills and Knowledge

    A. The kinds of experience listed below have proven to be useful indicators of successful performance as a member. From your knowledge of the applicant, how well do you think he or she has performed each of the following:
  • Section III: Social Sensitivity

    A. From you knowledge of the applicant, how well do you think he or she has demonstrated the following in his/her life:
  • Section IV: Additional Comments

  • Section V: Overall Recommendation

  • Confidentiality Statement

    The Privacy Act is a federal law which states that everyone has the right to know about and receive information about, or copies of, documents about them which are maintained by the federal government. This law provides that Belleville AmeriCorps may keep the identity of the source of this reference confidential only if you request that it be kept confidential.