Applicant's Name

The above named person has applied for a position as a counselor at our co-ed residential summer camp located in Northeastern Pennsylvania.

The position requires the counselor to live with 12 children and 2 co-counselors for an 8-week period. The job is quite demanding and we are looking for applicants who exhibit maturity and good judgement. The counselor is being entrusted with another person's child and as such we look to their references to help us determine if they possess the character to take on such a responsibility.

We are asking for your critical appraisal and confidential evaluation of this person. Please be candid and objective so we can be sure we are hiring only those applicants that posses the necessary character traits which will allow them to succeed.

If you have any questions please give us a call at 800-408-1404.

How long have you known the applicant?

In what capacity?

Would you hire/rehire this person?

If no, for what reason?

Is this the type of person who you would entrust to care for you own child?

What are the applicant's strengths?

What are the applicant's weaknesses?

Please describe the overall personality of the applicant?

Please finish the following sentence… The applicant seems happiest when……

To the best of you knowledge:

Has the applicant ever had any criminal convictions for child abuse or sexual abuse?
Yes No

Has the applicant ever had any criminal convictions for any other offense (felony or misdemeanor)?
Yes No

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School or Business

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Nighttime phone number

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