Name of applicant
*
Applicant's Phone Number (Mobile)
The applicant is seeking position as
Please Select
Camp Director
Leader
International Staff
Junior Staff/Leader
Home Staff
Junior Counselor
In the following CISV program
Applicant has provided CISV Programme and Leadership Description to Referee
yes
no
Is the person providing the reference a member of CISV?
yes
no
How long have you known the applicant?
Referring person sees / communicates with the applicant
often
sometimes
seldom
Referring person's relationship with Applicant
work supervisor
family friend
CISV member
teacher/professor
personal friend
co-worker
relative
student
Other
Information about the referring person
Name of Person Giving the Reference
*
Email address of referring person
Your email address
Phone number of referring person
Address of Referring Person
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
In my opinion, CISV would OR would not (please make clear which one in answer) benefit by having this Applicant in a position of responsibility in its cross-cultural and international peace education programmes for the following reasons:
Special skills or other comments
Declaration: To the best of my knowledge, the information I have provided about the Applicant is true, accurate and complete. I am not aware of past/present behaviour by the Applicant that would disqualify him/her from working with international youth, acting as an appropriate role model or functioning in a position of trust with CISV.
yes
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