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Online Reference Form Click here to download this form in PDF format (70k) Applicant’s name:  (Required) The person named above has applied for a position as a counselor in our co-educational children’s camp. Your critical appraisal and confidential evaluation of this person will be of great help in selecting our staff. It is most important for leaders of boys and girls to be of high ideals, possess integrity, get along well with others in the intimate life of camp, be attractive to children and demonstrate a willingness to do more than "his or her share." A counselor’s summer involves living and working with children between the ages of 7 to 15 for seven weeks. The counselor is with the children during the day, then sleeps in the same cabin with a group of children at night. Because living with children is very wearing, and because counselors live in close proximity to the campers, the experience is demanding. We would appreciate your providing confidential information about the applicant. On a number of occasions we find it necessary to hire on the basis of information supplied by references and statements made by the applicant. Therefore, we hope you will be quite frank, candid and objective so that we may avoid mistakes that could result in a serious inconvenience for us and perhaps termination for the employee. Thank you for your response and kind assistance. How long have you know the applicant? (Required) In what capacity? Would you hire / re-hire this person? Yes No Not Applicable If no, for what reason? Is this the type of person you would want as a counselor for a child of your own? Yes No Please explain if the answer is no: Motivation (Desire to learn) --- Select One --- Very ambitious Eager Average Indifferent Purposless Enthusiasm --- Select One --- Excellent Good Average Fair Poor Loyalty --- Select One --- Excellent Good Average Fair Poor Emotional Maturity (self-control) --- Select One --- Very Stable Well-Balanced Average Below Average Unstable Social Acceptability (response from others) --- Select One --- Sought out Well-liked Accepted Tolerated Avoided Tolerance --- Select One --- Excellent Good Average Fair Poor Energy --- Select One --- Excellent Good Average Fair Poor Responsibility --- Select One --- Always Assumes Often Seeks Accepts Avoids Never accepts Communication --- Select One --- Excellent Good Average Fair Poor Social Attitude (concern for others) --- Select One --- Deeply Concerned Interested Average Indifferent Anti-social Humor --- Select One --- Excellent Good Average Fair Poor Understanding Children --- Select One --- Excellent Good Average Fair Poor Leadership --- Select One --- Always leads Frequently Leads Seldom leads Follower Negative Ability to Accept Supervision & Guidance --- Select One --- Excellent Good Average Fair Poor Appearance --- Select One --- Excellent Above Average Average Summary --- Select One --- Outstanding Above Average Average Fair Doubtful What are this applicant's greatest strengths? Weaknesses? What extra-curricular activities are they involved with? To the best of your knowledge: Has the applicant ever had any criminal convictions for child abuse or sexual abuse offenses? No Yes Has the applicant ever had any criminal convictions for a felony or misdemeanor? No Yes Your Full Name Your Email Address School or Business Address Daytime Phone Number Evening Phone Number