Counselor Reference Form
This applicant has applied for a counselor position at one of our camp programs and has given your name as a reference. The Camp Rainbow programs are for children undergoing treatment for, and survivors of, cancer and blood- related disorders. Our camper’s age range is 4-13 years old. Counselors are responsible for an individual camper during our one week summer camp in June. We would appreciate you taking a few moments to complete the evaluation below for the said applicant. This information will be of greatest help to the applicant if returned promptly to our office. Information provided will be considered confidential.
Applicant Name
Your answer
Name of Reference
Your answer
Your Phone Number
Your answer
Your Email Address
Your answer
How long have you known this applicant?
Your answer
Your relationship to the applicant?
Your answer
Did the applicant work for you?
If yes, in what capacity?
Your answer
Would you employ this applicant in a position of leadership and responsibility?
Why or why not.
Your answer
The applicant relates well with peers
Strongly Agree
Strongly Disagree
The applicant accepts responsibility
Strongly Agree
Strongly Disagree
The applicant accepts supervision and guidance
Strongly Agree
Strongly Disagree
The applicant is emotionally mature and flexible in the face of change
Strongly Agree
Strongly Disagree
The applicant demonstrates leadership qualities
Strongly Agree
Strongly Disagree
The applicant is resourceful and shows initiative
Strongly Agree
Strongly Disagree
The applicant is creative
Strongly Agree
Strongly Disagree
The applicant demonstrates love for children
Strongly Agree
Strongly Disagree
The applicant is dependable
The applicant is honest
Would you hire the applicant as a caregiver to your child?
Please give a brief evaluation of the applicant's character.
Your answer
Additional Comments
Your answer
Electronic Signature
Your answer
Date
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