On The Go Staff/Intern Pastors Referral & Reference Form

(applicants name) ___________________________

The Applicant has chosen you as a reference and we would like you to give us your opinion regarding their fitness or ability to serve with On The Go Ministries/Keith Cook Evangelistic Association. This is confidential!
· What is your relationship to the applicant (check all that apply)
  1. __ Co-Worker  
  2. __ Relative  
  3. __ Good Friend  
  4. __ Casual Relationship
  5. __ Pastor  
  6. __ Youth Pastor  
  7. __ No Contact  
  8. __ Very Little Contact

· How long have you know the applicant?

· Why do you think the applicant wants to be a part of our ministry? (Check all that apply)
  1. __ Supportive of all On The Go is wanting to do
  2. __ Because it is exciting and new  
  3. __ Called to the missions or evangelism 
  4. __ Because everyone else is going  
  5. __ To have something to do
  6. __ To escape reality

· Which of the following describe the applicant (In your opinion) Circle the number of all that apply!

  1. Dedicated to the local church
  2. Fun to be around
  3. Moody
  4. Adventuresome
  5. Dedicated
  6. Rebellious
  7. Follower
  8. Leader
  9. Christian
  10. Church leader
  11. Critical
  12. Everyone admires
  13. Adaptable
  14. Dependable
  15. Mature
  16. Spiritual
  17. Athletic
  18. Argumentative
  19. Into Dating Heavy, Romantic
  20. Self Centered
  21. Driven

· Comments relating to any of the items above: (Please detail on back or on separate sheet)

· Use this code for the following questions! Circle: G-Good, A-Average, P-Poor, N-No basis to answer.

1. What is the Mental condition of the Applicant? G A P N

2. How doe the Applicant relate to Authority? G A P N

3. How does the Applicant's Peers relate to Him/Her? G A P N

4. How would you rate the Applicant's Leadership ability? G A P N

· What part does the Applicant play at His/Her Local Church?

· Does the Applicant have any Social/Moral habits that we should know about?

· Do you have any reservations about or lack confidence in the applicants ability to minister on an evangelistic outreach team/ministry? (please explain)

· Please read the following and mark the answer that closest represents your recommendation level for this applicant.

  1. __ Has my highest recommendation
  2. __ Has my recommendation based on limited knowledge
  3. __ I do not recommend the Applicant
  4. __ I recommend with some reservations (explain on back)

Signature: __________________________ Name: _________________________________________

Phone: _____________________________ Address: _______________________________________