Counselor/Candidate's Name*:

Reference Name*:

Title:

Your Email*:

Phone Number*:

Best time to be reached:

Please indicate the time to call in Eastern Time(EST).

Did you directly supervise applicant:*
 Yes No

How long and in what context have you known the applicant:*

If the applicant is a former employee, would you rehire:
 Yes No

If you would not rehire, why?,br />

What were the responsibilities this person had in this role:*

Based on your experience with the applicant, please rate the applicant in the following areas:

Maturity in social and intellectual areas:*
---OutstandingAbove AverageAverageFairBelow AverageUnknown

Supports policies:*
---OutstandingAbove AverageAverageFairBelow AverageUnknown

Acceptance of constructive feedback:*
---OutstandingAbove AverageAverageFairBelow AverageUnknown

Cooperation with supervisors:*
---OutstandingAbove AverageAverageFairBelow AverageUnknown

Concern for the individual child:*
---OutstandingAbove AverageAverageFairBelow AverageUnknown

Success in teaching/coaching (known or projected):*
---OutstandingAbove AverageAverageFairBelow AverageUnknown

Group management:*
---OutstandingAbove AverageAverageFairBelow AverageUnknown

Enthusiastic & vivacious in working with children:*
---OutstandingAbove AverageAverageFairBelow AverageUnknown

Attitude toward work:*
---OutstandingAbove AverageAverageFairBelow AverageUnknown

Consistency:*
---OutstandingAbove AverageAverageFairBelow AverageUnknown

Please identify and explain 3-5 traits the applicant has that will make them a role model for boys ages 7-15:*

What would you consider to be the greatest strength of this person:*

What area(s) would you have like to see some growth or improvement over time?:*

If you had a 10 year old son, would you feel comfortable placing him in the care of the applicant?:*
 Very Comfortable Comfortable Uncomfortable

To the best of your knowledge, does the applicant have any history of actual or alleged child abuse or sexual abuse, or ever been involved or convicted regarding a felony or misdemeanor?:*
 Yes No

Additional information regarding any known convictions:

Considering the applicant will be working with children, please add any additional comments of support or caution:

Additional Notes:

STATEMENT OF AGREEMENT
I hereby agree that the information provided above is accurate and truthful to the best of my knowledge. i understand that a camp representative can and may call to verify the information stated above:

Please check this box if you agree with the above statement:

Verification Code:(Please enter the code below in the space provided)