OREGON JUDICIAL DEPARTMENT
Citizen Review Board





Volunteer Board Member Reference Check Form
Date: 02/09/2010
Applicant Information


Applicant's First Name:
Applicant's Last Name:


Field Manager:


Reference Information


Name:
Email: Phone:


Reference Comments
*Note: Please provide the reference with a brief description of the CRB, volunteer duties and expectations, and local community context at the beginning of the conversation.


How long have you known the applicant? In what capacity?





Do you have any concerns regarding the applicant’s having access to confidential information concerning children and families?





What are the assets that you believe the applicant would bring to the Citizen Review Board?





How would you assess this person’s ability to ask clear, relevant, concise questions, listen carefully, and reach a decision?





Do you feel there is any reason the applicant should not be considered for this position?




Using the scale, please rate the volunteer’s abilities, for the following areas:


Excellent
Average
Poor
1
2
3
4
5

Dependability, Commitment, and Attendance 1 2 3 4 5

Maintaining Confidentiality 1 2 3 4 5

Objectivity 1 2 3 4 5

Ability to Learn and Apply New Skills 1 2 3 4 5

Professional Communication Skills 1 2 3 4 5

Active Listening Skills 1 2 3 4 5

Ability to Work as Part of a Team 1 2 3 4 5

Ability to Make Sound Judgments 1 2 3 4 5




Are there any ratings you feel that you would like to explain further?






Is there anything else you think we should consider regarding this applicant?







Thank you for your time and assistance.