Lindley G. Cook 4-H Camp Staff /Volunteer Reference Form
Due to the importance of the counselor selection process and the impact this applicant could have on the children we serve, we would appreciate your candid opinion of the applicant. All information is considered confidential and is strictly used for Lindley G. Cook 4-H Camp.
Your Full Name
Your answer
Your Occupation
Your answer
The best phone number to reach you at
(We may need to call to verify this reference)
Your answer
Applicant Name:
The name of the person applying for a position at our camp.
Your answer
How long and in what capacity have you known the applicant?
Please let us know how you know the applicant and for how long.
Your answer
Would you consider the applicant suitable for supervising children and youth for extended periods of time in a close community-living situation?
Your answer
What do you know about the applicant that makes him/her special?
Your answer
If given the opportunity, would you hire this person? Please explain.
Your answer
Maturity and Judgement
(Please indicate Excellent, Above Average, Average or Below Average)
Sense of Humor
(Please indicate Excellent, Above Average, Average or Below Average)
Emotional Stability
(Please indicate Excellent, Above Average, Average or Below Average)
Dependability
(Please indicate Excellent, Above Average, Average or Below Average)
Tact
(Please indicate Excellent, Above Average, Average or Below Average)
Initiative
(Please indicate Excellent, Above Average, Average or Below Average)
Patience
(Please indicate Excellent, Above Average, Average or Below Average)
Flexability
(Please indicate Excellent, Above Average, Average or Below Average)
Creativity
(Please indicate Excellent, Above Average, Average or Below Average)
Ability to Work with Others
(Please indicate Excellent, Above Average, Average or Below Average)
Completes tasks in a timely manner
(Please indicate Excellent, Above Average, Average or Below Average)
Accepts supervion at work
(Please indicate Excellent, Above Average, Average or Below Average)
Moral soundness
(Please indicate Excellent, Above Average, Average or Below Average)
Any additional information or comments that you would like to share about this applicant?
Your answer
Thank you for your assistance in providing the highest quality staff for our youth.
EQUAL OPPORTUNITY EMPLOYER: Rutgers Cooperative Extension, NJAES, Rutgers University, is an equal opportunity employer and seeks to employ the best qualified individual without regard to race, religion, color, national origin, ancestry, age, sex, sexual orientation, physical or mental handicap or disability, or marital, military, or veteran’s status.
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