Reference Form - Counselor/Op Staff

Date

Check back October 1 to apply for staff!

Name of Person Applying to serve at Camp

First NameLast Name

Your Name

First NameLast Name

Email

Your email address will be used for correspondence.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

You are:

How long and in what capacity have you known this applicant?

In your opinion, is this applicant fully qualified to work with children and youth?

Are you aware of anything in the applicant's background, personality, or behavior that could pose a threat to children or youth?

List a few strengths you have seen this applicant display.

List a few weaknesses you have seen this applicant display.

CHARACTER - desires to do and does what is right, integrity

	1	2	3	4	5

1 is Worst, 5 is Best

DEPENDABILITY - person of their word, punctual, follow-through

	1	2	3	4	5

1 is Worst, 5 is Best

COOPERATION - obeys authority, submissive, receives correction

	1	2	3	4	5

1 is Worst, 5 is Best

GENERAL INTELLIGENCE - common sense and scholastic ability

	1	2	3	4	5

1 is Worst, 5 is Best

ABILITY TO GET ALONG WITH OTHERS - selflessness, humility, teamwork

	1	2	3	4	5

1 is Worst, 5 is Best

RELATIONSHIP WITH FAMILY - on good terms, submissive, honoring

	1	2	3	4	5

1 is Worst, 5 is Best

RELATIONSHIP WITH GOD - devotional life, consecration

	1	2	3	4	5

1 is Worst, 5 is Best

Any Additional Comment or Explanations

"I certify that the information above is complete and true."

Signature

Date of Signature

Date

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HHBC Reference Form

Your Information

Applicant Information - written

Applicant information - scale