Staff Reference Form

Please complete ALL fields.

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NOTE: This form should be completed by a former employer, professor/teacher, supervisor, coach, clergyman, or other person aware of your efforts or work with children. Personal friends and babysitting references are not acceptable.

The applicant is applying to work at SUMMIT CAMP, a specialized sleepaway camp program for children with attentional issues. It is a demanding environment that often requires patience, perspective, and boundless energy. Staff need to be consistent, upbeat, flexible and nurturing. They need to be willing to accept direction and suggestions. They also need to be able to work as part of a team - just as parents might when raising their own children.

Note: * indicates a required field.

Applicant Details

Last Name (Applicant): *

First Name (Applicant): *

Professional Relationship

Where/How did you supervise this applicant? *

How long have you known this applicant? *

Would you employ this person again? Yes No *

Attribute Ratings

Please select the appropriate categories based on your knowledge of the applicant. Please select "unknown" if not applicable:

Acceptability * Enthusiasm * Physical Stamina * Accepts Supervision * Initative * Reliability * Common Sense * Insightfulness * Self Image * Concern for Others * Integrity * Sensitivity * Desire to Learn * Leadership Ability * Tact * Emotional Maturity * Patience * Temperament *

Abilities with Children

Do you believe this applicant can work well with children? Yes No *

Would you entrust your own children to this person? Yes No *

Would you employ this applicant to a position working directly with children? Yes No *

Our campers often present issues of management, and/or behavior. Please comment on this applicant's ability to work in this environment: *

Your Details

Last Name: * First Name: * Mailing Address 1: * Mailing Address 2: City: * State/Province: ZIP Code: * Country: * Email: * Phone (Office): * Phone (Home/Cell):

More Information

May we contact you for additional information? Yes No *

Staff Reference Form

Page 2 (Submission)

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Your form has been sucessfully submitted. We appreciate the time you have taken to complete this reference!

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