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Gym City Character Reference
Employment Opportunity Character References
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Applicants Name
Your answer
1. How long have you known the applicant?
Your answer
2) What is your association/relationship with the applicant?
Your answer
3) Do you have any reason to suspect that the applicant is not suited to work with or around children of any age in an unsupervised environment? YES / NO. If yes, please explain:
Your answer
4) To the best of your knowledge, has this person ever been convicted of or pleaded guilty to child abuse or any violent crimes? YES / NO
Yes
No
Clear selection
5) To the best of your knowledge, has the applicant ever been fired/ dismissed/ terminated or been asked to resign from a position because of failure to carry out responsibilities? YES / NO
Yes
No
Clear selection
6) Please summarize your opinion of this applicant’s character, in particular their suitability to work with or around children. Confidentiality assured!
Your answer
Signature
Your answer
Name
Your answer
Date
MM
/
DD
/
YYYY
Address
Your answer
Phone Number
Your answer
Email
Your answer
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