Reference Form – Year in Mission & Service 2020-2021 Full name of referee* First Last Occupation* Company/organisation* Home Address* Street Address Address Line 2 City County / State / 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 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 Country Email* Enter Email Confirm Email Phone number (inc. country and area code)*How long have you known the applicant?* In what capacity do you know the applicant?* Reasoning & Comprehension* brilliant, exceptional capability makes thoughtful analysis alert, has good mind average mental ability learns and thinks slowly Interpersonal Relationships* listens accurately to others responds to the feelings and needs of others initiates friendships and cares for others resolves interpersonal conflicts relates well to individuals of other races/cultures develops relationships with individuals of other races/cultures impatient with others easily irritated Work Habits* serves beyond what is required superior creative ability consistently reliable organized detail oriented overly perfectionistic does only what is assigned easily irritated meets average expectation unorganized starts but often does not finish Emotional Strength* able to work in difficult and isolated situations good control in difficult situations accepts constructive criticism flexible in the face of change able and willing to adapt perseveres through difficulties usually well balanced easily discouraged overly emotional Adventist Lifestyle & Standards* lives in harmony with accepts understands somewhat rigid challenges ignores Teamwork* works well with others follows directions prefers to work in a team prefers to work alone frequently causes friction prefers a structured environment prefers an open environment tends to be domineering Spirituality* exceptional insight and discipline active faith immature faith dedicated growing somewhat rigid beliefs searching has made basic commitment uncommitted Leadership* exceptional leadership inspires others respectful of others has some leadership skills tries but lacks ability prefers supportive roles makes no attempt to lead Church Doctrines* understands lives in harmony with accepts somewhat rigid Personality/Sociability* seeks others out makes friends easily accepts others reserved, but friendly avoids others conceited critical of others shy or withdrawn moody or sullen easily offended lacks a sense of humor Communication* skilled in public speaking speaks clearly and tactfully writes clearly and tactfully able to express thoughts sometimes hard to understand Knowledge of the Bible* superior grasp well established basic, but improving sketchy, limited Perception of Others* sought after by others liked by others tolerated by others avoided by others Spiritual Influence* positive passive negative Relationship to Authority* relates well to persons of authority accepts authority tolerates authority challenges authority resists authority often argumentative Rate the applicant:* Excellent Above Average Average Below Average Not Acceptable 1. Describe any special performance-related skills or abilities you feel would contribute to the success of the applicant in mission service.2. Describe any performance-related weakness or tendency you believe might reduce the effectiveness of the applicant in their overall performance of mission service.3. Describe any performance-related event, situation or experience (positive or negative) the applicant has experienced recently which you feel might impact his/her service?4. Use this space for additional comments or remarks.I confirm that, to the best of my knowledge, the information given in this form is correct and complete.Referee’s signature* Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920
