Staff Reference Form (Christian Worker)
Reference Information
Applicant Name
Your answer
Reference Name
Your answer
Organization and Job Title
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Email Address
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Phone Number
Your answer
Relationship to Applicant
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How long have you known the applicant and in what capacity?
Your answer
Multiple Choice Evaluation
How well is the applicant able to direct and influence others?
How well does the applicant work with others?
How well does this person react to suggestions or criticisms from others?
How does the applicant demonstrate a lifestyle committed to upholding values and integrity?
How responsible is the applicant to complete assigned tasks?
How well is the applicant able to maintain his/her focus on a particular task?
How willing is the applicant to accomplish work set before him/her?
How well does the applicant control his/her emotions?
Please provide any additional comments you may have regarding the Multiple Choice Evaluation:
Your answer
Ranking Evaluation
Please rank the applicant's ability in each area as you've experienced.
1 = low; 10 = high
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10
Teachability
Promptness
Ability to follow instructions
Outgoing
Emotional balance
Ability to work with children
Ability to work with youth
Fulfilling obligations
Sense of humor
Temper control
Ability to follow through with commitments and responsibilities
Enthusiasm
Trustworthiness
Ability to get along with others
Tactfulness
Friendliness
Leadership ability
Please provide any additional comments you may have regarding the Ranking Evaluation:
Your answer
Additional Questions
Would you be willing to hire this person to work in any of the positions he/she is asking to be considered for at Pine Lake Camps? Please explain why.
Your answer
Would you be willing to place your child under the applicant's direct care and influence? Please explain why.
Your answer
Please comment on the applicant's maturity of judgment. How does this person react in stressful situations (i.e. making decisions)?
Your answer
Please comment on the applicant's dependability. Can he/she be relied upon? Does this person weaken in the absence of supervision?
Your answer
From your observation of the applicant, please list his/her three greatest strengths:
Your answer
From your observation of the applicant, please list his/her three most significant weaknesses:
Your answer
Do you think the applicant has an unhealthy dependence on camp, particularly Pine Lake camps? If yes, please explain.
Your answer
I expect the applicant's work to be:
Indicate your recommendation for the applicant:
If you do recommend the applicant, why do you offer your recommendation?
Please provide any additional comments you feel will be helpful for our consideration of the applicant:
Your answer
We understand that there may be additional information best communicated over the phone. Would you like a Pine Lake Camps representative to contact you for further information?
If you select "yes", you will be contacted at the phone number provided on this form.
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