An individual has applied to work at Camp Ronald McDonald at Eagle Lake as a volunteer this summer. They have given your name as a reference that could evaluate their performance as well as potential for the above position. Please give careful consideration to the ratings below.
REFERENCE REQUEST FOR*
Today's Date
Month Day Year
Date
Your Name & Position*
Company Name & Address*
Relationship with applicant*
1. Performance Evaluation
Please check the items for which you have sufficient knowledge about applicant:

	Excellent	Very Good	Good	Fair	Not Applicable
Integrity
Work Habits/ Organization
Adaptability/ Flexibility
Attitude
Relationship with Co-Workers
Leadership Abilities
Ability to work in groups
Responsibility
Ability to relate to children
Children's response to applicant
Maturity
Perseverance

2. Objective Rating
Under each heading, check the phrase that most accurately describes applicant:
Ability to direct and influence others:*
Exceptional leadership qualities Usually successful in leading others Unreliable leadership qualities
Ability to work & cooperate with others:*
Gets along exceptionally in groups-team player Will cooperate in most circumstances Gives limited cooperation - better suited to solitary work
Ability to relate and give guidance to children:*
Children naturally get along very well with applicant Children adequately participate Children often ignore instructions Unknown to this reference
Ability to follow through with job assignments:*
Completes tasks promptly, often does more than expected Completes assigned tasks at own pace Needs constant supervision to complete work
Ability to control emotions*
Well-balanced, good control Average ability to control emotions Frequently irritated, impatient or depressed Poor
How would you rate applicant as a role model for children:
Excellent Very Good Fair Poor
Would you be willing and completely comfortable leaving your children under applicants supervision? (Please explain)*
Does applicant show signs of any behavior that would cause concern when working with children?*
How many years have you known applicant?
How do you know applicant?*
Please comment on the applicant's suitability for this program:
I declare that to the best of my knowledge the information I have given in this reference is correct and complete*
I Agree
Name
First Name Last Name
E-mail
Phone Number
Area Code Phone Number
Should be Empty:

1. Performance Evaluation

2. Objective Rating