Reference FormVeronica Jesuthasan2019-12-06T12:23:32+00:00 Reference Form Name of Applicant* First Last Name of Person Providing Reference* First Last Address of Person Providing Reference* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Phone*Please evaluate the applicant as fairly as you are able by marking your ratings on the following continuums. If you don't feel qualified to give an answer in a particular area, please mark it as Don't Know. Your responses will be kept confidential. SPIRITUALSalvation*Evaluate the applicant's demonstration of being born again. (0-little evidence, 10-strong evidence) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Relationship with Christ*Evaluate daily practice of his/her faith (0-inconsistent, 10-consistent) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Church Involvement*Evaluate relationship with local church (0-uninvolved, 10-deeply involved) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Trust in God*Is the applicant anxious or trusting? (0-constantly anxious, 10-consistently trusting God) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Ministry Skills*Is the applicant capably involved in ministry? (0-uninvolved, 10-capably involved) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Knowledge of Scripture*(0-very limited, 10-exceptional) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Concern for and Witness to the Lost*(0-unconcerned, 10-actively witnessing) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Comments on any of the abovePERSONALWork Habits*(0-sloppy/unreliable, 10-reliable/precise) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Initiative*Does the applicant take the initiative in most situations? (0-always waits for others, 10-self starter) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Relationship to Authority*How does the applicant respond to authority? (0-rebellious, 10-respectful) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Cooperation*Does the applicant function well as a part of a team? (0-difficulty with teams, 10-consistent team player) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Social Acceptance*How does the applicant's personality affect others? (0-tolerated, 10-sought after) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Acceptance of Others*How responsive is the applicant to others' feelings? (0-narrow and unresponsive, 10-exceptionally understanding) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Emotional Stability*(0-insecure/reactive, 10-secure/stable) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Family Relationships*(0-poor, 10-excellent) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Flexibility*How well does the applicant adapt? (0-rigid, 10-consistently able to adapt) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Focus*Does the applicant have a strong sense of purpose/calling? (0-wavering, 10-strongly committed) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Appearance*Evaluate the applicant's personal appearance. (0-sloppy, 10-always neat) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Poise*Evaluate the applicant's public demeanor. (0-lacks confidence, 10-consistently confident) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Leadership*Is the applicant a leader? (0-never leads, 10-strong leader) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Communication*Does the applicant present thoughts with clarity? (0-not able to communicate clearly, 10-very articulate) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Ministry Potential*How would you rate the applicant's probability of success in cross-cultural ministry? (0-poor, 10-excellent) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Relationships with the Opposite Sex*(0-careless, 10-very discreet) 0 1 2 3 4 5 6 7 8 9 10 Don't Know Comments on any of the aboveHow long have you known the applicant and in what relationship?*Does the applicant hold any beliefs that differ from historical evangelicalism?* YES NO If yes, please briefly explain.Is there anything, in your opinion, that would prevent the applicant from being successfully involved in cross-cultural ministry?*What would you consider to be the applicant's greatest strengths?*What would you consider to be the applicant's weak areas?*Influence on Applicant*Is there any indication that the applicant's desire for missionary service has been significantly influenced by: A desire for travel or adventure, a desire to exercise power or control over less privileged people or a desire to escape a difficult situation? Explain brieflyPlease include any comments you may have on the applicant which you feel have not been covered (or have been inadequately covered) in other sections of this form. Please be frank.Consent* By checking this box, I agree that everything is true and accurate.Signature (Name)* Date* MM slash DD slash YYYY
