Volunteer Reference Form

Volunteers

Thank you for taking the time to complete this reference form. You have been listed as a reference for a volunteer applicant with authorization to release the information requested. This information will be kept in strict confidence. Please e-mail us at volunteers@aspirus.org or call us at 715.847.2848 if you have questions.

Our program requires discipline, dependability, responsibility, pleasing personality, the ability to get along with others, personal neatness, and the ability to accept and follow directions.

In the hospice/home care environment and the hospital environment, volunteers must respect all information concerning the organization and patients as confidential.

*Denotes required fields.

Qualities
Your Name: *
Applicant's First Name: *
Applicant's Last Name: *
Your E-mail: *
Your phone number: *
Please rate the applicant’s qualities below on a scale from 1-10 using the following criteria: 1-3: Poor Range 4-7: Average Range 8-10: Excellent Range
Attitude *
Ability to get along with others *
Appearance *
Dependability *
Ability to follow instructions *
What is your relationship to the applicant? *
How long have you known the applicant? *
What do you see as the applicant’s strengths? *
Has the applicant shown that they can maintain confidentiality? *
If so, could you provide an example?
Additional Comments?
By submitting this form, I attest that the information I have provided on the form is true and accurate. *

Aspirus Wausau Hospital

Passion for excellence. Compassion for people.

Volunteers

Volunteer Reference Form

Volunteer Reference Form

Apply To Become a Volunteer