BSVM Employer Reference Please ask an individual who has supervised you in a paid position for at least six months to complete this form. Employer Reference About Bon Secours Volunteer MinistryBon Secours Volunteer Ministry, sponsored by the Sisters of Bon Secours, provides the opportunity for women and men to participate in the Sisters’ commitment to justice in radical solidarity with the poor, the suffering, and those most in need. In order to do this, Bon Secours Volunteer Ministry supports individuals throughout a year of full-time service primarily within an urban neighborhood in Baltimore, Maryland or Richmond, Virginia. Due to our specialization in health care, education, and social service, Bon Secours Volunteers minister in hospitals, clinics, public health settings, tuition-free private schools, family resource centers, adult learning centers, and other agencies which strive to address the needs of people who face economic injustice. In addition to learning from their full-time service, Bon Secours volunteers commit to: develop an intentional community, grow spiritually, live simply, and practice God’s justice. Throughout this year, volunteers discover that by sharing the Bon Secours’ charism of compassion, healing, and liberation with others they, in turn, receive the charism from those they serve. Applicant Name* First Last Reference Name* First Last TitleAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* About this Reference FormWe ask that you help us to get to know the applicant as we consider his or her acceptability to the mission and commitments of Bon Secours Volunteer Ministry. No applicant will be rejected on the basis of a single reference. Feel free to omit any questions that you are not prepared to answer. Your response is an integral part of the application process and we appreciate your time. 1) How long have you known the applicant?2) Please describe the context of your relationship with the applicant.3) After considering the above description of Bon Secours Volunteer Ministry, do you feel that the applicant is a strong candidate? Why or why not?4) What makes the applicant unique? In a few sentences, please describe the applicant’s character and outstanding personality traits.5) Please briefly describe the applicant’s strengths and limitations.6) Please describe a time when the applicant demonstrated strong leadership skills in a particular situation at work.Please rate the applicant’s ability or experience with each of the following:Work Well with OthersPoorBelow AverageAverageAbove AverageOutstandingNot ObservedWork IndependentlyPoorBelow AverageAverageAbove AverageOutstandingNot ObservedAdapt to New Situations at WorkPoorBelow AverageAverageAbove AverageOutstandingNot ObservedHandle StressPoorBelow AverageAverageAbove AverageOutstandingNot ObservedNavigate Disagreements or ConflictPoorBelow AverageAverageAbove AverageOutstandingNot ObservedManage Their TimePoorBelow AverageAverageAbove AverageOutstandingNot ObservedComplete Tasks on TimePoorBelow AverageAverageAbove AverageOutstandingNot ObservedBe Open to Professional GrowthPoorBelow AverageAverageAbove AverageOutstandingNot ObservedAccept Supervision and Respond to FeedbackPoorBelow AverageAverageAbove AverageOutstandingNot ObservedWork with a Diverse Group of PeoplePoorBelow AverageAverageAbove AverageOutstandingNot ObservedIf given the opportunity, would you re-hire the applicant? Why? Why not?Additional Comments:RECOMMENDATION*Highly recommendRecommendRecommend with reservationsDo not recommendElectronic Signature* Checking this box serves as my electronic signatureI certify that I am the person named above and these answers represent my own opinion and feelings.
