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Staff Reference Form

Thank you for taking the time to fill out the reference form below. Your input is very helpful in selecting leaders for the La Vida Adventure Camp. This form will be used in conjunction with an application, interview, and other references. If filling out a reference for a counselor in training applicant, please use this form instead.

Please complete this form in a timely manner. Interviews with applicants will not be scheduled until all references are in. Applications and references are accepted only as long as positions are open.

PLEASE NOTE: This form needs to be completed within 20 minutes or the page will time-out and all information will be lost. Many people find it easier to write their thoughts in a document first and then copy and paste the material into this form.

Adventure Camp Staff Reference Form

1. Applicant's Name

2. Reference Name

3. Reference Phone Number

4. Reference E-mail

5. How long have you known the applicant?

6. How do you know him or her (in what capacity)?

7. Please rank the applicant's leadership potential.

8. Please rank the applicant's emotional maturity

9. Please rank the applicant's judgment and decision-making skills.

10. Please rank the applicant's work ethic.

11. Please rank the applicant's integrity.

12. Please rank the applicant's communication skills.

13. Please rank the applicant's ability to work with others.

14. Please rank the applicant's faith commitment.

15. Please rank the applicant's dependability.

16. Comments or clarification about your responses in questions 7-15.

17. Listed below are traits that may limit the applicant's effectiveness in some positions. Please check any traits you have observed in the applicant (presence of these traits will not automatically disqualify an applicant from a leadership position).

Controlling or domineering
Easily embarrassed
Easily depressed
Easily discouraged
Easily irritated
Frequently worried, anxious or nervous
Given to exclusive and absorbing relationships
Prejudiced toward groups, races or nationalities
Withdrawn or overly quiet
Very Critical or Jokingly Critical
None Observed

18. Comments or clarification about any items you checked in question 17.

19. What are three of the applicant's strengths?

20. What are three areas in which the applicant needs further development?

21. What leadership traits does this applicant possess?

22. Adventure Camp staff have responsibility for camper safety, programming, team-building, adventure activities, working with peers and being a role model. Based on your knowledge of the applicant, please explain how you feel that he or she would perform in a leadership position?

23. Do you recommend this individual for a position with the La Vida Adventure Camp?

Strongly recommend
Recommend with reservations
Do not recommend

24. Additional Comments

25. Signature