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Staff Reference Form

Your name has been submitted to us as a reference for the below named applicant. He/She seeks a position at our resident camp for children ages seven to sixteen. The responsibilities are demanding, varied and require the ability to live and work closely with the children as well as other staff members. We are interested in filling this position with a candidate who will benefit from the experience professionally and personally while contributing to our camp program. Your honest reply will be considered privileged and confidential information. Thank you for your help.

Applicant Information

Applicant's First Name
Applicant's Last Name
What is your relationship to the applicant?
How long have you known the applicant?
What position or work did they perform?
What were the results of their performance?
Would you rehire this individual?
On a scale of 1-10 (10 being the best), how comfortable would you be leaving your own child in the care of this applicant?
On a scale of 1-10 (10 being the best), how do you think this applicant will respond to criticism?
On a scale of 1-10 (10 being the best), how do you rate the level of responsibility of this applicant to work in a camp enviornment?

How does the applicant relate to co-workers, supervisors, peers, children?


How does the applicant perform under stress?


What are the applicants skills and how well are they used?


Do you have any additional information that may be helpful in our evaluation of this applicant?

Your Contact Information

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Full Name
Job Title
Organization or Company
Daytime Phone Number	(e.g. 212-555-1212)
E-mail Address