Character Reference Affidavit

CHARACTER REFERENCE AFFIDAVIT

RE: {Name of person whose character is being addressed}

1. Your name: _________________________________________________

2. Your address: _______________________________________________

3. Date of birth: _______________________

4. Contact number: ______________________

5. Your employer: ______________________________________________

6. What is your occupation? ______________________________________

7. How long have you known {Name}? ___________

8. What is your relationship to {Name}? ____________________________

9. Do you have reason to believe {Name} has ever broken the law?

If yes, explain: _______________________________________________

___________________________________________________________

___________________________________________________________

10. Do you know if {Name} has ever been fired from a job?

If yes, explain: _______________________________________________

___________________________________________________________

___________________________________________________________

11. Has {Name} ever suffered from mental illness, to the best of your knowledge?

If yes, explain: _______________________________________________

___________________________________________________________

___________________________________________________________

12. Does {Name} misuse drugs or alcohol?

If yes, explain: _______________________________________________

___________________________________________________________

___________________________________________________________

13. Do you believe {Name} is generally of good moral character?

If yes, explain: _______________________________________________

___________________________________________________________

___________________________________________________________

Please add any additional comments:

Signed:

____________________________                     ____________________________
Reference Name                                                   Reference Signature

STATE OF ______________________________

COUNTY OF ______________________________

Subscribed and sworn to before me

on ______________________________

NOTARY SEAL:

______________________________
Notary Public Name

______________________________
Notary Public Signature

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