Re: _______________________________________________________________
(Applicant's name)
The above applicant has applied for membership with the Peekskill Youth Ambulance Corps and has offered your name as a reference. To assist us in determining this candidate's eligibility for membership plese fill out and send by mail or type up in and send by email., Should you have and questions or concerns please feel free to call the Youth Corps Membership board, at 914-737-5310.
Thank you for your assistance.
1. How long, and in what capacity, have you known the candidate?
_____________ year(s)
2. How would you rate this candidate's dependability 1 being worst 10 the best?
1 2 3 4 5 6 7 8 9 10
3. How would you evaluate this candidate's initiative?
_________________________________________________________________________________________
_________________________________________________________________________________________.
4. Please comment on the integrity of this candidate.
_________________________________________________________________________________________
_________________________________________________________________________________________.
5. In your opinion, is this candidate able to perform under stressful situations? If possible, please provide an example. ___________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
_________________________________________________________________________________________.
6. To your knowledge, has this candidate been involved in activities that demonstrate concern for others? Please describe. ___________________________________________________________________________________
___________________________________________________________________________________________
_____________________________________________________________________________________.
7. Can you offer any further insights regarding this candidate's qualifications to become a member of the Peekskill Youth Ambulance Corps
Signature________________________________________________ Date / /
Please print name, address and phone number:
_______________________________________
_______________________________________
_______________________________________
_______________________________________
Please return to:
Email:
[email protected]
Mai:l
Peekskill Community Volunteer Youth Ambulance Corps
1427 Main Street
Peekskill, New York 10566