PLEASE TYPE OR USE BLACK INK FOR CLEAR DUPLICATION

General Board of Global Ministries
475 Riverside Drive - Room 320 New York, New York 10115 U.S.A.
Phone: (212) 870-3660       Fax: (212) 870-3774


CONFIDENTIAL

Personal Reference for:_______________________________________.

WordPerfect version of this Reference Form

Instructions: Please use a scale of 5 (exceptional) to 1 (low). Make comments on factors considered in arriving at your rating.

Characteristics: Rating: Comments:
ADAPTABILITY
in facing new situations
5    4    3    2   1
  
EMOTIONAL STABILITY
under pressure
5    4    3    2   1
  
INVOLVEMENT
in Church, School and Community
5    4    3    2   1
  
LEADERSHIP
of others and group process
5    4    3    2   1
  
DEPENDABILITY
in completing tasks
5    4    3    2   1
  
COMMUNICATING
with others effectively
5    4    3    2   1
  
CREATIVITY
and resourcefulness
5    4    3    2   1
  
EASE OF RELATIONSHIPS
with persons of different
backgrounds and faiths
5    4    3    2   1
  
QUALITY
of Christian faith and commitment
5    4    3    2   1
RELATIONSHIP
with authority figures
5    4    3    2   1
  

Signature:__________________________________________Date:___________
Occupation:__________________Relationship to applicant: __________________
Telephone: Home-_______________________Work-______________________

Please return to Antonietta A. Wilson at the address at the top of the page.

| Mission Opportunities | GBGM | GBGM Employment | Mission Personnel |