Chi Rho Corps Member Application: Self Reference

Note to Applicants: As part of the application process, we ask that you complete this self-reference and return
it with your application.

Please answer all questions as fully as possible.  Attach extra sheets if necessary.

Return completed form to:

Todd Tesoro
Chi Rho Catholic Service Corps
15 Eld Street
New Haven, CT 06511

Your name:_________________________________________________________

What are your greatest strengths?




What are your most significant weaknesses?




How would you describe your personality?  How effectively do you interact with others?




Describe your work habits.  How effectively do you handle conflicts and problem situations?




How well-suited are you to working with the needy of the inner city?  Please explain.




How well-suited are you to living simply in a community?  Please explain.






On a scale of 1 to 5 (with 5 being highest) how would you rate yourself in these areas?

Honesty and Integrity                ___                
Open-mindedness                    ___
Dependability                           ___                
Creativity                                  ___
Emotional Stability                    ___               
Level of Religious Practice       ___
Maturity                                    ___                
Christian Values                       ___
Ability to Work with Others       ___               
Health and Stamina                 ___

How do you recommend yourself?        
___ Highly                ___ With reservations                __ Not Recommended

________________________________________________________________________
Signature                                        Date                        Telephone Number