Confidential Reference Form
Thank you for taking the time to assist us in the hiring process. This is a confidential document. All information obtained will be kept confidential. The person this reference is for will not see this form when you have finished, nor should they be present as you fill it out.
A negative (or honest) response to the questions below will not necessarily exclude the applicant from being hired, but will rather allow us (in all confidence) to interview the applicant in a manner that will help us best decide whether they are right for service in our particular ministry. Please feel free to contact me if you have any concerns or questions.
Please note: The person for whom you are filling out this form will not be considered for hire until you have submitted this confidential form.
Tom O'Brien
tom@bethelchristiancamp.org
Contact Info
In case we need more details regarding this reference.
Your Full Name*
First Name Last Name
Your Phone Number*
Area Code Phone Number
Your Email*
Information about the Applicant
Applicant Full Name (NOT your name)*
The name of the person for whom you are filling out this reference form
What is your relationship to the applicant?*
How well do you know the applicant?*
Very Well Somewhat Well Classroom Only Business Only
What level of communication have you had with the applicant in the last year?*
Frequent Moderate Little
Job Responsibilities
The Primary Responsibilities of Sr. Staff (18+) include:
Living with and managing a cabin of 10 campers ages 7-16, leading a Bible study, leading recreation, teaching specialized classes in an area of expertise, personal counseling and acting as a spiritual leader as well as a role model for hundreds of children.
The Primary Responsibilities of Jr. Staff (under 18) include:
Working alongside other teenagers ages 14-18, working long hours, maintaining the highest quality in assigned areas, and acting as a spiritual leader as well as a role model for campers.
Personality
Please rate the applicant on a 1-5 scale with 5 being the BEST. Please skip any questions in which you have no knowledge.
Work Ethic
1 2 3 4 5
1 is Worst, 5 is Best
Trustworthiness
1 2 3 4 5
1 is Worst, 5 is Best
Evidence of Being a Team Player
1 2 3 4 5
1 is Worst, 5 is Best
Flexibility
1 2 3 4 5
1 is Worst, 5 is Best
Tact
1 2 3 4 5
1 is Worst, 5 is Best
Emotional Balance
1 2 3 4 5
1 is Worst, 5 is Best
Anything you would like to elaborate on concerning the above?
Suitability for Employment in a Residential Camp Setting
Please answer these questions to the best of your knowledge
Do you feel the applicant is spiritually, emotionally, and physically ready for a demanding summer?*
Yes No Unsure
Do you know of any lifestyle, conduct, or activity in which this individual is or has been involved that could hinder his or her ministry with us, or impede the program’s credibility?*
Yes No
Do you have any knowledge of this person ever being convicted of a child abuse, child neglect, or sexual abuse offense?*
Yes No
Do you have any knowledge of this person having ever been formally accused in a written statement of a crime of any nature or of a pending criminal or civil trial?*
Yes No
Is there any reason you are aware of that the applicant should not be allowed to work with children in a residential camp setting?*
Yes No
Have you ever noticed any racial prejudice in the life of the applicant that would make cooperation with those of another race or nationality difficult?*
Yes No
How well does the applicant receive instruction or deserved criticism from a supervisor or teacher?*
Very Well Well Well, depending on the situation Poorly I have no knowledge regarding this question
How well does the applicant know the bible?
Above Average Average Below Average Unsure
Please describe the applicant's judgement and common sense.*
Would YOU hire this person for this ministry if you were in the position to do so?*
Yes, without reservation Yes, with some reservations No Unsure
If yes, do you think this person should work at camp because of what he/she can contribute to our program, or because of what we can do for him/her? If no, why? Please explain in as much detail as possible.*
Please place a check in the box that best describes the applicant.

Please CHECK ALL that apply.

Please skip any questions in which you have no knowledge.
Peer Relationships
Very Popular Makes Friends Easily Slow to Make Friends Generally a Loner
Family / Home Relationships
Healthy and supportive Healthy, but not currently supportive Problematic, but supportive Problematic and not supportive
Response to stress / pressure
Copes Well Adapts Slowly Withdrawals Dominates the situation Becomes overly critical of others
Applicant relates to the opposite sex
Relates Well Mature / Appropriate Inappropriate Insensitive Insecure Discriminatory / Sexist Unhealthy
Level of Spiritual Maturity
Mature and Consistent Maturing / Fairly Consistent Growing / Showing signs of continued maturity Up and Down / Inconsistent spiritual experience Immature
Ability to work independently and under supervision
Independent worker / able to take direction and go Works well once given direction Needs regular supervision Needs accountability Does not respond well to supervision Lazy
Working Relationships
Works well with others Average ability to work with others Occasional difficulty working with others Does not work well with others
When conflict arises, this person generally responds with:
Peacemaking Openness to resolving conflict Confrontation Withdrawal / Avoidance Lack of cooperation Defensive / Critical Attitude
Is there anything else you think we should know about the applicant or their suitability to be a part of the summer staff at Bethel? This is your chance to sing their praise or confidentially warn us about a potentially bad hire.
Digital Signature
Thank you for taking the time to fill out this reference.
By signing below I am stating that in my opinion this applicant is:*
A Must Hire Highly Recommended Recommended Recommended with some reservations Not recommended by me for your ministry this summer
Signature*
Please type your full name above
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Confidential Reference Form

Contact Info

Information about the Applicant

Personality

Suitability for Employment in a Residential Camp Setting

Digital Signature