ConfidentialCatholicPastoralReferenceFormforaLeadershipPosition
Ifyouanyquestionsaboutthisform,pleasecontactHumanResourceServicesatthePeterboroughVictoria
NorthumberlandandClaringtonCatholicDistrictSchoolBoardat705-748-4861or1-800-461-8009
PleasePrint
Name ofApplicant:Name ofPastor:
Parish:
Date:
KNOWLEDGE OF THE CANDIDATE
Checkoneor moreofthefollowing.
Ihave ...ongoing personal knowledge ofthe individual as a member ofthe parish
personal knowledge ofthe individual in the past
knowledge ofthe candidate’s family
knowledge throughapersonal interview
other ( please specify)
AdditionalComments:
REFERENCE
Youmaywishtoanswerorcommentonsomeorallofthefollowing:
1. The candidate participates in thesacramental life ofthe Church.
regularly
occasionally
infrequently
not known
AdditionalComments:
2. The candidate is involved in service: inthe Church, in the broader community ( e.g.
Lector, Youth Group, Outofthe Cold, Food Bank ).
yes
no
not known tome
AdditionalComments:
3. The candidate has shown a commitment totheCatholic faith over the period oftime thatIhave known him/her.
yes
no
not known tome
AdditionalComments:
4. Inmy opinion the candidate has demonstrated qualitiesthatdisplay leadership ability which would serve the Board wellshould the candidate take a leadership position in the Board.
yes
no
not known tome
AdditionalComments:
Pleasefeelfreetoaddanyadditionalcommentsbelow:
SignatureofCatholicPriest:
Date:
INFORMATIONCOLLECTIONAUTHORIZATION: ThisinformationiscollectedpursuanttotheMunicipalFreedom ofInformationandProtectionofPrivacyAct,1989,andwillbeusedto determineemploymentwith PVNCCDSB. This informationwillbestoredinHumanResourceServices. Anyquestionswithrespecttothisinformationshouldbe
directed toHuman ResourceServices.
11/2012