References Welcome to our online Reference Form. If you have any questions while filling in this reference form please don't hesitate to contact us, you can also save your progress as you go and return to complete the form at a later date. Prospective Volunteer Name Outreach Referee Details Relationship to Applicant Please select... Employer Pastor Other If 'Other', please specify your relationship to the applicant. First Name * Last Name * Street City / Town * Post Code / Zip * State / Province Country * Please select... Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos ( Keeling ) Islands Colombia Comoros Congo Cook Islands Costa Rica Côte d ' Ivoire Croatia ( Hrvatska ) Cuba Cyprus Czech Republic Congo ( DRC ) Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands ( Islas Malvinas ) Faroe Islands Fiji Islands Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong SAR Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao SAR Macedonia, Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Samoa San Marino São Tomé and Prìncipe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and the Grenadines Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Viet Nam Virgin Islands ( British ) Virgin Islands Wallis and Futuna Yemen Zambia Zimbabwe Phone (Home) * Phone (Mobile) Email * Position Occupation Church School YWAM Centre Location Youth with a Mission (YWAM) is a worldwide Christian movement operating in more than 150 countries since 1960. YWAM is decentralised in structure; each centre is financially and legally autonomous, allowing locations to adapt and serve the specific needs of the community. YWAM MSA is a Christian charity that aims to serve, build, care and connect with individuals and communities. YWAM MSA values individuals’ rights to quality of life. The shared motivation is to provide people with: Access to good health care Food, drinking water and shelter Opportunity for education Expression of culture, arts and entertainment Healthy relationships Exposure to Christian faith and values Fair and productive government Opportunity to work and develop YWAM MSA is actively developing communities by addressing the health care and training needs in Papua New Guinea (PNG) alongside the priorities and vision of the PNG National Health Plan PNG National Department of Education, and AusAID’s commitment to the UN’s Millennium Development Goals. YWAM MSA is implementing programs with its Medical Ship and land-based teams in rural PNG communities in association with key stakeholders and partners. The majority of YWAM MSA staff, including the Managing Director, are full-time volunteers. Vision YWAM MSA’s vision is based on the need for a respectful and collaborative partnership with the people of PNG and Australia. The aim is to see major sustainable health improvement in PNG while simultaneously seeing relationships strengthened between Australia and PNG. Mission To see improved quality of life for the people of PNG through development-focused programmes, with current emphasis on the health sector, while also building Australians’ capacity to serve through volunteering. How long have you known the applicant? On a scale of 1-10 how well do you feel you know the applicant? Please select... 1 (very little) 2 3 4 5 6 7 8 9 10 (intimately) How would you rate the applicant in the following areas? Initiative / Self-starter SuperiorAbove AverageAverageBelow AverageInferior Concern for Others SuperiorAbove AverageAverageBelow AverageInferior Ability to Follow Direction SuperiorAbove AverageAverageBelow AverageInferior Leadership SuperiorAbove AverageAverageBelow AverageInferior Judgement / Decision Making SuperiorAbove AverageAverageBelow AverageInferior Response to Authority Figures SuperiorAbove AverageAverageBelow AverageInferior General Health SuperiorAbove AverageAverageBelow AverageInferior Personal Appearance / Grooming SuperiorAbove AverageAverageBelow AverageInferior Comments Academic / Mental Ability SuperiorAverageInferior Reliability SuperiorAverageInferior Cooperativeness SuperiorAverageInferior Flexibility SuperiorAverageInferior Disposition SuperiorAverageInferior Punctuality SuperiorAverageInferior Time Management SuperiorAverageInferior Financial Responsibilty SuperiorAverageInferior Willingness to be Accountable SuperiorAverageInferior Comments In your observations, how does the applicant adapt to changing social environments? Please choose only one response. Excellent - Applicant adapts to various social environments quickly and genuinely, engaging in relationships. Normal - Settles well into different environments and initiates and maintains relationships Reserved - Applicant is hesitant to engage in groups but tends to become more comfortable once a relationship has been initiated with him/her. Withdrawn - Applicant appears anxious in groups and tends to withdraw; does not engage in any relationship and isolates self. Comments Please rate the applicant as to his/her maturity and stability. Outstanding - Mature. Has proven ability to operate under stress and pressure More mature and emotionally stable than average. Possesses adequate emotional stability and maturity. Doubtful - Experience has shown that the applicant may not be able to endure stress. Applicant has frequently demonstrated signs of inability to cope with stress. Comment How does the applicant react in trying situations? Please select... Withdraws Gets Angry Accepts Patiently Gets Discouraged Meets Constructively Other please specify Please comment on applicants' strengths and weaknesses. Strengths Weaknesses In your opinion, which of the following areas of ministry is the applicant gifted. (Please check all that apply) CommunicationsArtDramaMusicWorshipPastoringEvangelismPrayerCounsellingPreachingTeachingDiscipleshipYouth MinistriesChildren's WorkNursingDoctorEncouragerHospitalityAdministratorServant-Hearted Please list any other abilities you have observed Are there any other areas of ministry or service that you would recommend this applicant for? Please add any relevant remarks (i.e. medical, psychological, drug or alcohol related, or any other life situations we should be aware of). Please comment on the applicant's family background, if known. Would you have this person on your staff? YesNo Comment Would you recommend the applicant for acceptance by YWAM Medical Ships Australia? Please select... Yes, unreservedly Yes No Comment I certify that the information provided is complete and accurate according to my knowledge of the applicant. * YesNo We would like to keep you informed and updated on our ministry. If you would NOT like to receive these updates please untick this box. Contact: YWAM Medical Ships - Australia PO BOX 1959 Townsville, QLD, 4810 Australia Phone: +61 7 4771 2123 Email: firstname.lastname@example.orgWebsite: www.ywamships.org.au Please do not hesitate to contact us if you have any questions. Need assistance with this form?