Utica Zoo Summer Camp Staff 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 the Utica Zoo.
Your Full Name *
Your Occupation *
The best phone number to reach you at *
(We may need to call to verify this reference)
Applicant Name: *
The name of the person applying for a position at our camp.
How long and in what capacity have you known the applicant? *
Please let us know how you know the applicant and for how long.
Would you consider the applicant suitable for supervising children and youth for extended periods of time in a close community situation? *
What do you know about the applicant that makes him/her special? *
If given the opportunity, would you hire this person? Please explain. *
Maturity and Judgement
(Please indicate Excellent, Above Average, Average or Below Average)
Clear selection
Sense of Humor
(Please indicate Excellent, Above Average, Average or Below Average)
Clear selection
Emotional Stability
(Please indicate Excellent, Above Average, Average or Below Average)
Clear selection
Dependability
(Please indicate Excellent, Above Average, Average or Below Average)
Clear selection
Tact
(Please indicate Excellent, Above Average, Average or Below Average)
Clear selection
Initiative
(Please indicate Excellent, Above Average, Average or Below Average)
Clear selection
Patience
(Please indicate Excellent, Above Average, Average or Below Average)
Clear selection
Flexability
(Please indicate Excellent, Above Average, Average or Below Average)
Clear selection
Creativity
(Please indicate Excellent, Above Average, Average or Below Average)
Clear selection
Ability to Work with Others
(Please indicate Excellent, Above Average, Average or Below Average)
Clear selection
Completes tasks in a timely manner
(Please indicate Excellent, Above Average, Average or Below Average)
Clear selection
Accepts supervision at work
(Please indicate Excellent, Above Average, Average or Below Average)
Clear selection
Moral soundness
(Please indicate Excellent, Above Average, Average or Below Average)
Clear selection
Any additional information or comments that you would like to share about this applicant?
Thank you for your assistance in providing the highest quality staff for our youth.
It is the policy of the Utica Zoological Society to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law.
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