Reference Form

Applicant's Name

Position

The above-named individual has applied for a position with The Maternity Home of the Hudson Valley. MHHV would appreciate a confidential statement from you concerning the applicant's conformity to the qualities listed below and their expected ability to carry out their duties for MHHV. Please include how long and in what capacity you have known the applicant.

Desired Qualities – As part of MHHV, the applicant will work for or with women who may be facing the decision of an unplanned pregnancy. Some of the qualities desired in staff and volunteers are:

A genuine commitment to Jesus Christ as Savior and Lord of their life.
A willingness to give of themselves with compassion to the women they will serve.
Dependability and responsibility to perform their role and corresponding activities with excellence.
An ability to uphold their commitments to the Mission, Values, and Policies of MHHV.

Your comments concerning the applicant's conformity to the qualities listed above

Please check the best rating for the areas listed

Please rank these areas with the scale:
1 - Below Average
2 - Average
3 - Above Average

Your Information

First Name

Last Name

Church

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Phone (Day)

By typing your name below you are e-signing this form

Date

Thank you for being a reference for an applicant

Please check the best rating for the areas listed

Your Information