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1. Covenant Harbor Reference Form

100% of survey complete.

You have been selected as a reference by an individual applying for employment at Covenant Harbor Bible Camp. We are looking for mature, hard working, trustworthy, Christian applicants who will be positive role models for children ages 6 - 18. Your honest appraisal is necessary to help us evaluate the applicants qualifications and abilities. All comments are confidential.

If you have any questions or concerns, please contact a Covenant Harbor Youth Ministry Team member at (262)-248-3600. Learn more about Covenant Harbor at www.covenantharbor.org.

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* 1. Applicant Name:

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* 2. Please share information about yourself.

Your Name: *

Organization: *

Email Address:

Phone Number: *

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* 3. How long have you known the applicant and in what capacity?

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* 4. How well do you know the applicant?

Not very well

Fairly well

Very well

Close Relationship

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* 5. How recent is your interaction with the applicant?

More than one year since interaction

Occasional interaction in the past year

Consistent interaction in the past year

Regular contact

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* 6. Who would benefit more from the applicant's time at Covenant Harbor, the applicant or the campers? Why?

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* 7. Would you feel comfortable leaving your own child in the care of the applicant?

Yes

Other (please specify)

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* 8. Please select ALL qualities that describe the applicant's WORK HABITS.

Completes tasks on own accord

Confronts issues in a Godly manner

Does over and above

Follows suggestions willingly

Lazy

Meets average expectations

Needs constant supervision

Needs prodding

Neglects common good for own interests

Procrastinates

Resents suggestions

Self-starter

Teachable

Unusual perseverance

Other (please specify)

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* 9. Please select ALL qualities that describe the applicant's LEADERSHIP ABILITY AND STYLE.

Poor ability

Average ability

Good ability

Exceptional ability

Usually follows

Natural leader

Servant leader

Dominant

Takes over

Delegates well

Other (please specify)

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* 10. Please select ALL qualities that describe the applicant's SOCIAL INTERACTION with peers and adults.

Avoided by others

Tolerated by others

Liked by others

Well-liked by others

Sought out by others

Example for others

Respected

Creates divisiveness

Respectful

Manipulative

Shys away

Socially awkward

Good conversationalist

Other (please specify)

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* 11. Please select ALL qualities that describe the applicant's PERSONALITY.

Anxious

Cold

Compassionate

Extroverted

Friendly

Fun-loving

Genuine

Likeable

Needy

Outgoing

Overbearing

Personable

Quiet

Shy

Warm

Withdrawn

Other (please specify)

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* 12. Please select ALL qualities that describe the applicant's EMOTIONAL STABILITY.

Listens to others' needs

Needy

Often overresponds

Relatively stable

Self-controlled

Tends to be moody

Unstable

Well-balanced

Other (please specify)

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* 13. Please rate the applicant in the following areas, comparing the applicant to other people his or her age.

	Poor	Below Average	Average	Above Average	Good	Excellent	Not Sure
Flexibility	Flexibility Poor	Flexibility Below Average	Flexibility Average	Flexibility Above Average	Flexibility Good	Flexibility Excellent	Flexibility Not Sure
Judgment	Judgment Poor	Judgment Below Average	Judgment Average	Judgment Above Average	Judgment Good	Judgment Excellent	Judgment Not Sure
Dependability	Dependability Poor	Dependability Below Average	Dependability Average	Dependability Above Average	Dependability Good	Dependability Excellent	Dependability Not Sure
Rapport with kids	Rapport with kids Poor	Rapport with kids Below Average	Rapport with kids Average	Rapport with kids Above Average	Rapport with kids Good	Rapport with kids Excellent	Rapport with kids Not Sure
Integrity	Integrity Poor	Integrity Below Average	Integrity Average	Integrity Above Average	Integrity Good	Integrity Excellent	Integrity Not Sure
Decision making	Decision making Poor	Decision making Below Average	Decision making Average	Decision making Above Average	Decision making Good	Decision making Excellent	Decision making Not Sure
Health/Stamina	Health/Stamina Poor	Health/Stamina Below Average	Health/Stamina Average	Health/Stamina Above Average	Health/Stamina Good	Health/Stamina Excellent	Health/Stamina Not Sure
Team Participation	Team Participation Poor	Team Participation Below Average	Team Participation Average	Team Participation Above Average	Team Participation Good	Team Participation Excellent	Team Participation Not Sure
Humility	Humility Poor	Humility Below Average	Humility Average	Humility Above Average	Humility Good	Humility Excellent	Humility Not Sure
Cooperation	Cooperation Poor	Cooperation Below Average	Cooperation Average	Cooperation Above Average	Cooperation Good	Cooperation Excellent	Cooperation Not Sure
First Impression	First Impression Poor	First Impression Below Average	First Impression Average	First Impression Above Average	First Impression Good	First Impression Excellent	First Impression Not Sure
Creative	Creative Poor	Creative Below Average	Creative Average	Creative Above Average	Creative Good	Creative Excellent	Creative Not Sure
Servant Heart	Servant Heart Poor	Servant Heart Below Average	Servant Heart Average	Servant Heart Above Average	Servant Heart Good	Servant Heart Excellent	Servant Heart Not Sure
Spiritual Maturity	Spiritual Maturity Poor	Spiritual Maturity Below Average	Spiritual Maturity Average	Spiritual Maturity Above Average	Spiritual Maturity Good	Spiritual Maturity Excellent	Spiritual Maturity Not Sure
Christian Values	Christian Values Poor	Christian Values Below Average	Christian Values Average	Christian Values Above Average	Christian Values Good	Christian Values Excellent	Christian Values Not Sure

Other (please specify)

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* 14. Please rate the presence of the following in the applicant.

	Often Apparent	Sometimes Apparent	Rarely Apparent	Never Apparent	Not sure
Anxiety	Anxiety Often Apparent	Anxiety Sometimes Apparent	Anxiety Rarely Apparent	Anxiety Never Apparent	Anxiety Not sure
Argumentativeness	Argumentativeness Often Apparent	Argumentativeness Sometimes Apparent	Argumentativeness Rarely Apparent	Argumentativeness Never Apparent	Argumentativeness Not sure
Critical Attitude	Critical Attitude Often Apparent	Critical Attitude Sometimes Apparent	Critical Attitude Rarely Apparent	Critical Attitude Never Apparent	Critical Attitude Not sure
Rebelliousness	Rebelliousness Often Apparent	Rebelliousness Sometimes Apparent	Rebelliousness Rarely Apparent	Rebelliousness Never Apparent	Rebelliousness Not sure
Rudeness	Rudeness Often Apparent	Rudeness Sometimes Apparent	Rudeness Rarely Apparent	Rudeness Never Apparent	Rudeness Not sure

Other (please specify)

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* 15. List two words that best describe the applicant.

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* 16. What is the greatest strength of the applicant?

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* 17. What is one area you would encourage the applicant to grow in?

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* 18. Is there any other information that would be helpful to Covenant Harbor in considering the applicant for employment?

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* 19. Overall, do you recommend the applicant for a position at Covenant Harbor?

Strongly recommend

Recommend

Recommend with hesitation

Do not recommend

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* 20. Thank you for sharing your input on this applicant. By typing your name below, you are verifying that the information listed previously is true to the best of your knowledge.