I (Applicants Name (required))

hereby release or authorize (Reference’s Name (required))

to provide a full and honest assessment of my character to Barron Gymnastics.

The applicant listed above recently applied for employment at Barron Gymnastics. Barron Gymnastics employees work
with and around children and families. Therefore, in order to be considered for employment, all applicants are required
to supply three written character references to help our company accurately assess each applicant’s suitability for
employment. You are requested to please fill out the questions below and attach a letter of reference for the applicant.
Please return the form and letter to the address or email listed below. Time is of the essence and we assure you
confidentiality.

Thank you for your thoughtful assistance,
Julie Barron, Owner, Barron Gymnastics
5411 Jedmed Ct., St. Louis, MO 63129
[email protected]

1) How long have you known the applicant?

2) Describe your association/relationship with the applicant. (friend, co-worker, relative, etc.)

3) Do you have any reason to suspect that the applicant is not suited to work with or around children of any age in an unsupervised environment?
YesNo

If yes, please explain:

4) To the best of your knowledge, has this person ever been convicted of or pleaded guilty to child abuse or any violent crimes, or had a child removed from their home?

5) To the best of your knowledge, has the applicant ever been dismissed or been asked to resign from a position because of failure to carry out responsibilities?

6) Please use the space here and on back if needed, or attach a letter of reference summarizing your opinion of the applicant’s character, in particular, their suitability to work with or around children. Confidentiality assured.

Signature of Reference:

Date:

Reference Phone#:

Email: