Confidential Reference Form

Lets someone who knows the applicant confidentially complete a character and suitability assessment before they are hired to work with children at a camp.

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Your Full Name

Nombre

Apellido

Your Phone Number

Your Email

Name of the Person You Are Providing This Reference For

Nombre

Apellido

What Is Your Relationship to the Applicant?

How Well Do You Know the Applicant?

Not Very Well Somewhat Well Well Very Well

What Level of Communication Have You Had with the Applicant in the Last Year?

Frequent Occasional Rare None

Anything You Would Like to Elaborate on Concerning the Above?

Do You Feel the Applicant Is Spiritually, Emotionally, and Physically Ready for a Demanding Summer?

Yes No

Do You Know of Any Lifestyle, Conduct, or Activity This Individual Is or Has Been Involved in That Could Hinder Their Work with Us or Affect the Program's Credibility?

Yes No

Do You Have Any Knowledge of This Person Ever Being Convicted of Child Abuse, Child Neglect, or Sexual Abuse?

Yes No

Do You Have Any Knowledge of This Person Having Been Formally Accused in Writing of Any Crime, or of a Pending Criminal or Civil Trial?

Yes No

Is There Any Reason You Are Aware of That the Applicant Should Not Be Allowed to Work with Children in a Residential Camp Setting?

Yes No

Have You Ever Noticed Any Racial Prejudice in the Applicant's Life That Would Make Cooperation with People of Another Race or Nationality Difficult?

Yes No

How Well Does the Applicant Receive Instruction or Deserved Criticism from a Supervisor or Teacher?

Very Well Well Adequately Poorly

How Well Does the Applicant Know the Bible?

Very Well Well Somewhat Not Well

Please Describe the Applicant's Judgment and Common Sense.

Would You Hire This Person for This Ministry if You Were in the Position to Do So?

Yes No

If Yes, Do You Think This Person Should Work at Camp Because of What They Can Contribute to Our Program, or Because of What We Can Do for Them? If No, Please Explain in Detail.

Please Rate the Following Areas

Peer Relationships

Excellent Good Fair Poor

Family / Home Relationships

Excellent Good Fair Poor

Response to Stress / Pressure

Excellent Good Fair Poor

How the Applicant Relates to the Opposite Sex

Excellent Good Fair Poor

Level of Spiritual Maturity

Excellent Good Fair Poor

Ability to Work Independently and Under Supervision

Excellent Good Fair Poor

Working Relationships

Excellent Good Fair Poor

When Conflict Arises, This Person Generally Responds With:

Avoids Conflict Addresses It Directly Becomes Defensive Seeks Mediation

Is There Anything Else You Think We Should Know About the Applicant or Their Suitability to Join the Summer Staff? This Is Your Chance to Praise Them or Confidentially Flag a Concern.

By Signing Below, I Am Stating That in My Opinion This Applicant Is:

Highly Recommended Recommended Recommended with Reservations Not Recommended

Signature

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Confidential Reference Form

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