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Reference Check (Please print legibly)
Thank you for completing and returning this reference form. We are grateful for your time and input. If you would like to talk to an LFS staff member about this application, please call (402) 978-5665. Lutheran Family Services of Nebraska Volunteer Management 124 South 24th Street, Suite 230 Omaha, NE 68102 Fax (402) 978-5660  hr@LFSneb.org

Dear _______________________________________, I am applying for a volunteer position with Lutheran Family Services of Nebraska (LFS) and am asking you to be a reference. Please answer the following questions to the best of your knowledge. LFS will use this information to help place me within their programs. Thank you for your help and cooperation. Sincerely, ___________________________________________ Applicant _______________ Date

Position(s) Desired: City I am willing to serve:

Reference Information
Reference Name:
First Last

Reference Address:
Street Address Apartment/Unit #

City

State

ZIP Code

Home Phone: E-mail: What is your relationship to the applicant? How long have you known the applicant?

Alternate Phone:

(Use arrow keys to select.) Have you seen this person work with children? If yes, please describe their level of comfort and ability in the space below.

Yes

No

Have you seen this persons work with adults? If yes, please describe their level of comfort and ability in the space below.

Yes

No

In the space below, name a time the applicant was working with children or adults.

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Please rate this applicant on the following by marking in the appropriate box:
Skills
Ability to work with diverse groups Ability to accept responsibility Ability to make and keep commitments Time management skills Flexibility Customer service Organizational skills What are the applicant’s two strongest qualities? Above Average Average Below Average Don’t Know

What are the applicant’s two biggest challenges?

Additional comments:

By submitting this form to LFS, I certify that I provided the reference information above in good faith and all statements contained herein are true and accurate. I also give my permission for LFS to use this information to assess the noted volunteer applicant. Signature of Reference:
(Signature not required when submitting by internet)

Date:

When the form is complete, save it to your hard drive then attach it in an email to hr@lfsneb.org
After submitting form, protect your information by pressing the "Clear All Answers" button.

Clear All Answers