Reference Form for Camp Wyoming Summer Staff
This form is to be completed by a reference for an individual applying for a summer staff position at Camp Wyoming. Camp Wyoming would greatly appreciate your honest and candid feedback of this individual as they will be directly responsible for the day-to-day care of children and youth. The information in this form will remain completely confidential. The candidate cannot continue in the hiring process until this reference form is received, and due to the nature of the work, relatives and peers are disqualified from serving as references.

Please answer each of the questions below to the best of your ability. Feel free to use additional sheets of paper should the need arise. If you have an questions, please do not hesitate to call the camp office at (563) 488-3893 or email Thank you for taking the time to complete this reference and in doing so, supporting the success of Camp Wyoming.

Name of the Applicant for whom you are supplying a reference: *
Your answer
Date *
Your answer
Your name *
Your answer
Phone number (in case we have further questions) *
Your answer
Your job title/company *
Your answer
Email Address *
Your answer
Please describe the capacity in which you have known the applicant and for how long. *
Your answer
Have you observed the applicant with children or youth? *
If you answered "yes" to the question above, in what context have you observed them? Please also describe how they related to the children or youth in their care.
Your answer
If the applicant has worked for you in the past, would you rehire him/her? *
Why or why not?
Your answer
Describe the applicant’s personality (i.e. enthusiasm, poise, tact, etc.) in light of our organizational emphasis on developing caring relationships with campers. *
Your answer
What evidence have you seen that the applicant is trying to live a Christ-like life? *
Your answer
Has any information ever come to your attention from any source suggesting that the applicant might have ever physically, sexually, or emotionally abused any child or youth? *
If yes, please provide a detailed description.
Your answer
Please rate the applicant in each of the following categories:
General Behavior *
Enthusiasm *
Teamwork *
Creativity and Imagination *
Cleanliness/Personal Hygiene *
Dependability *
Conflict Management *
Moral Standards *
Communication Skills *
Personal Motivation *
Ability to Receive Critical Feedback *
Self-Confidence *
Responsibility *
Emotional Stability *
Stress Management *
Social Skills *
Please indicate which statement you feel accurately reflects your recommendation of the individual. *
By signing and submitting this form you attest that you have answered the above questions as accurately as possible based upon your personal experience with the applicant. Furthermore, you attest that you are not related to the applicant in any way and have no personal stake in whether the applicant is accepted or not.
Type your name below to indicate a signature *
Your answer
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