Summer Staff Reference Form Reference Form ENReference FormAll information you can give us is appreciated and is confidential.YOUR First NameYOUR Last NamePhone/MobileEmailAddressAddress Line 1Address Line 2CityProvincePostal CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)ReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweGeneral QuestionsApplicant’s First NameApplicant’s Last NameHow well do you know the applicant? (1 – not very well, 5 – extremely well)Not very wellA littleAverageWellWe’re very closeHow recent is your last contact with the applicant?How many years have you known the applicant?What is your relationship to the applicant?If the applicant were to be a charge of kids, would you be happy to have them be in charge of your child?– Select –YesNoWhy would you rather not have this applicant in charge of your childs?Why would you be pleased that this applicant is in charge of your childs?Which reference are you providing for this applicant. Personal Professional/Employer SpiritualPersonalProfessional/EmployerSpiritualWould you have this applicant as a member of your team in the future? Yes No MaybeDoes the applicant work positively with others?Have you seen spiritual growth in the applicant throughout your time knowing them?Would you describe the applicant’s spiritual life as active and engaged?What qualities does the applicant have that are beneficial to summer camp?How have you seen growth in the applicant throughout the time of you knowing them? Give detailsHow does the applicant handle high-stress situations?Are there any undesirable or negative characteristics that we should be aware of?How does the applicant deal with conflict?Please comment on ONLY the characteristics you have had the opportunity to observeN/APoorFairGoodExceptionally GoodAbility to get along with othersAbility to leadAttitude towards superiorsAttitude towards opposite sexAttitude towards school/workCapacity for workConcern for childrenDependabilityInitiativeIntegrityWillingness to receive constructive criticismWe cannot accept a reference that is completely “Exceptionally good”. Thank you for your time and honesty!Please select any/all of the following characteristics which you feel describe the applicant. Moody Joyful Impatient Refined Shy Comfortable in crowds Loud Loving None of the abovePlease select any/all of the following characteristics which you feel describe the applicant. Enthusiastic Opinionated Gentle Superficial Adaptable Headstrong Patient Mean/Bully None of the abovePlease select any/all of the following characteristics which you feel describe the applicant. Sensible Lazy Honest Selfish Kind Peaceful Touchy Faithful None of the aboveSignature Sign Here DateSubmit Form
