Form

158 MILLBROOK ROAD

BLAIRSTOWN, NEW JERSEY 07825

http://www.princeton.edu/princetonblairstown

Phone: (908) 362-6765

Fax: (908) 362-7699

The Princeton-Blairstown Center (PBC) is a non-profit organization that runs adventure-based programs throughout the year. We focus on the development of self-confidence, individual responsibility, interpersonal and group living skills. The Center works with a variety of age groups and populations -- inner-city youth and their families, prep schools, adult volunteer groups. Employees live at the Center and facilitate outdoor activities, which include but are not limited to: high and low ropes courses, group initiatives and games, rappelling, canoeing, hiking and rock-climbing. Employees also assist with logistical support and routine equipment and facilities maintenance.

The applicant has selected you as a reference. Your honest and timely response will greatly assist our employment decisions.

Please rate the applicant on the following abilities and merits:

Applicant's Full Name

First Name Last Name

1. Character and Integrity

2. Dependability and Consistency

3. Sound Judgment and Maturity

4. Safety Consciousness

5. Enthusiasm and Sense of Humor

6. Flexibility and Creativity

7. Responds Positively to Supervisors

8. Accepts Constructive Criticism Well

9. Sensitive and Caring

10. Accepts and Relates with Co-Workers

1. How long, and in what capacity, have you known the applicant?

2. How does the applicant work with and/or relate to co-workers? Peers?

3. How does this person relate to children?

4. Do you know of any reason why this person should not be given a position of trust with children?

5. How does the applicant function during periods of stress or anger?

6. Have you ever had the opportunity to offer the applicant constructive feedback and if yes, how did the applicant respond?

7. Please summarize the applicant's strengths.

8. In what areas does the applicant need more growth?

9. Is there anything else that you would like to tell us regarding the applicant's possible employment at Princeton-Blairstown Center?

Thank you for your honest and constructive comments

Reference's Full Name:

First Name Last Name

Title/Position:

E-mail

Phone Number

- Area Code Phone Number

Address:

City:

State / Province:

Zip / Postal code:

Today's Date:

/ Month / Day Year

By submitting this form I certify that I completed it myself, and that all entries on it and information in it are true and complete to the best of my knowledge.

PRINCETON-BLAIRSTOWN CENTER

REFERENCE FORM