Reference Fonn Personal Infonnation - Episcopal Church

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Reference Fonn. Theapplicamshouldtill in ... I. PersonalandProfessionalQualities: 5. 4. 3. 2. 1. Unknown. Inventiveness. 0. 0. 0. 0. 0. 0. Initiat:ve. 0. 0. 0. 0. 0. 0.
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MISSION PERSONNEL EpISCOPAL CHl"RCH CE."TIER 815 Second Avenue New York, NY 10017

t -800-334-7626 exl 6124 212-983-6377

Reference Fonn Theapplicamshouldtill in thissectionandsubmi~it to the personfrom wooma referenceissought.

IPleasetypeorprint

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Pleasecheckappropr~atecateaory:

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From

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?elsonwhoknowsyouwell Employeror Supervisor, or Professor, Advisor,GuidanceGoullselor(if s1udent)

ApPlicant'sName

First

Mid:lle

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BishQp". Priest

CaUeague

last

Nameof referance

Address.

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Th~ pers~n p:ovldlng I~e re1erenGOsholiid lill in IltisaecUDn

andsubmitit tothe MissionPersonnel 1

Theapplicantnamedabovewi$he:sto undertakeservice in domestic or overseasmissions. Forthis reason,both tile applicaJ1tandthe staff of the Missiun ParamnelOffice would like your response to the items listed below.We would alsoappreciateany other informatbn that youthinkmightcontributetoa better understandingof this person.No applicant will be acceptedor eliminatedsolely on the b:tsi$of positive or negativeratingsof onerecommendatim. Supportingevidencewill alwaystit obtainedfrom other sources.

adttres&. Officeat1heabove

Personal Infonnation I haveknownthis personfor

year(s}in the1ollowlngcircumstances.

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Relerence Fonn- 1

56-9302.1

OnaScalD 011-5(5beingthe highestrating)pleaserateilluapplicantacpordlng 10tfJefollowing - qll8lties:

I. PersonalandProfessionalQualities:

Inventiveness Initiat:ve Responsibility

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Socialadjustment

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Generosity

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$elf-confidence

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Studyhabits

Refiability Emotional stability

leadership

Common sense

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II. Maturity: A personservingin domestic oroverseumissicns oftenQxpartences diffIcultandtryingsItuations. Thelifedemands maturity and abilitytofaceavarietyofnituations inadifferentculturalccntext

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Sense ofhumor Industriousness

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Emotionalmaturity

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SoLlndness of judgment Aexibll Pelsevecance

Reilects Christian values ReOgnizeshi$/her

limitations

III. TeamMJrkAbility:

A. In general,I wouldsay thathe/she is: Likeable Independent Empathetic Tolerant Honet Out-golng Perceptive

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tl. In relations with a group I would 5irf that this parson: '5

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Functionswell

withingroup Functionswall

outside group Gandeal withconflict Canaccept criticism

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'$ respectedtJl groupmembers

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is supportive ofothers

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Isrecognized asa leader

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Accepts collaboratio'n 0 Seeks to collaborate 0

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withauthoritythisperson is: C. IndeaUng

Cooperative Straightfurwaid Opento dia10gue

Admitstoerror Offersconstructive

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IV.Motivation: It maybedifficult10weighthemotives whichleada person toseekmi$$iory service, Thesemotivesmaybebasedonpractical, personal. religiousorhumanitarian considerations', Inyourjudgment. whataretremotivesdetermining thisperson's missionaryl volunteer irterests?

V.FamilyCDosideraiions: A.If this personis married.inyourjudgmentdoyoufealthis coupleis Matureenoughintheir relationshipashusb~d andwife to makesucha commitment?

ReferenceForm- 3

B. How do ytlu see this ccmmitmentaffectin~their marriage and children if theyhavechildren?

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VI.

Gel1erallmpresslons:

Please makeit stat~rnentreg~dingyour.overan impressionsof this pltrSOn. Please includeInyouransweranappraisal ofthetype ofinfluance helshewillexertonothersandareaswhereyouthinkhelshemightencounter difficulUes. .

VII. Other

Comments:

Noformcanoo\'srall point~ Anyotheraspectswhichyoufeelwillhelpusin ourC\laluation wouldbeapprecia1ed.

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VIII.

OVerall Evaluation:

I recommood this personfor seI'\Iicein donwsticor overseasmissions:

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wit:wutreservation

o withreseroatlon

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no

Bcplain if nocessary:

SIGNATURE

Please directly

.mlll this 10rm tn~

DATE

Mission Personnel Episcopal Church Center 815 Second Ave New York, NY 10017

RAferenr.a Form- 4