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Summer Camp Reference Form 2013
2.
Summer Camp Staff Reference
1.
Section One
Candidate Name
Desired Position
Date
2.
Camp Applicant is applying for.
Camp Maripai (Prescott)
Shadow Rim Ranch (Payson)
Willow Springs Program Center (Prescott)
Traveling Day Camp
*
3.
The candidate named above has selected you to evaluate his/her character, experience, past performance and potential for a seasonal summer camp position with Girl Scouts Arizona Cactus Pine Council. Please complete all of the questions found in this form.
(Required.)
Name of Reference
Occupation
Day Phone
Evening Phone
Email
How do you know the candidate?
How long have you know the candidate?
*
4.
Please choose the phrase that you believe most accurately describes this candidate's typical behavior. Please keep in mind that if selected, this individual will be responsible for the care and safety of several children in a camp setting.
1= Unacceptable - below minimum requirements and cannot be tolerated
2= Poor -- does not consistently meet expectations, uneven performance or results
3= Good -- solid performance, expectations are met, no significant misses
4= Above Average -- exceeds reasonable standards, significantly above average
5=Great -- consistently demonstrates extraordinary and exceptional accomplishments.
N/A = Have not seen them in this role.
(Required.)
1
2
3
4
5
N/A
Leadership
1
2
3
4
5
N/A
Teamwork
1
2
3
4
5
N/A
Work Ethic
1
2
3
4
5
N/A
Character
1
2
3
4
5
N/A
Emotional Maturity
1
2
3
4
5
N/A
Please provided us with additional comments that would be helpful in evaluating this candidate
*
5.
How would you feel about the candidate caring for your child or a child you know for several days in a camp setting?
(Required.)
*
6.
Describe the candidate's interactions with children.
(Required.)
*
7.
Do you have any reason to believe this candidate would ever abuse a child physically, sexually or emotionally?
(Required.)
Yes
No
If yes, please explain
*
8.
Do you feel this candidate has healthy personal relationships?
(Required.)
Yes
No
*
9.
What improvements could this individual make to better qualify her/him for the desired position?
(Required.)
*
10.
To what extent, if any, does the candidate use these substances?
(Required.)
Alcohol
Drugs
Tobacco
*
11.
To your knowledge has this individual ever been convicted of a crime?
(Required.)
yes
no