Reference Form

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Download the Staff Reference Form

In accordance with the Children's Online Privacy Protection Act a person must be 13 years of age or older to complete and submit this form.

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has applied to work as a staff member at Camp Mataponi. Your name has been given to us as a reference and we would greatly appreciate your cooperation in helping with our decision. Your opinions will be held strictly confidential and will be weighed heavily in our hiring process.
In what capacity have you known the applicant?
How long have you known the applicant?
Does the applicant work well with groups?
What would you note as the applicant's strengths?
What would you note as the applicant's weaknesses?
Has the applicant, to your knowledge, ever been involved in drugs?
If you were sending your child to summer camp, would you want to the applicant to be your child's counselor?
Would you hire/re-hire this person?	Yes No Not Applicable
Please rate the applicant on the following qualities on a scale from 1 - 5: 1 - Poor, 2 - Fair, 3 - Average, 4 - Good, 5 - Excellent, or NA
Integrity/Sincerity N/A 1 2 3 4 5 Ability to learn N/A 1 2 3 4 5 Attitude N/A 1 2 3 4 5 Initiative N/A 1 2 3 4 5 Leadership N/A 1 2 3 4 5 Creativity N/A 1 2 3 4 5 Emotional Stability N/A 1 2 3 4 5 Adjustment to situations N/A 1 2 3 4 5 Ability to accept supervision N/A 1 2 3 4 5 Judgment N/A 1 2 3 4 5 Sensitivity toward children N/A 1 2 3 4 5 Maturity N/A 1 2 3 4 5 Interaction with adults N/A 1 2 3 4 5 Physical Health N/A 1 2 3 4 5 Loyalty N/A 1 2 3 4 5 Personal Appearance N/A 1 2 3 4 5 Enthusiasm N/A 1 2 3 4 5 Assertiveness N/A 1 2 3 4 5 Adaptability and Flexibility N/A 1 2 3 4 5 Willingness to learn N/A 1 2 3 4 5
Additional Comments:
Your Name:
Position:
Daytime Phone:
Evening Phone:
E-mail: