Starlight Staff Reference Form

Online Reference Form

Name of Applicant: (Required)

The person named above has applied for a summer position at Camp Starlight. Your critical appraisal and confidential evaluation of this person will be of great help in selecting our staff.

A counselor’s summer involves living and working with children between the ages of 8 to 16 for seven weeks. The counselor is with the children during the day, and then sleeps in the same cabin with a group of children at night. Because living with children is very wearing, and because counselors live in close proximity to the campers, the experience is demanding.

We would appreciate your providing confidential information about the applicant. On a number of occasions we find it necessary to hire on the basis of information supplied by references and statements made by the applicant. Therefore, we hope you will be quite frank, candid and objective so that we may avoid mistakes that could result in a serious inconvenience for us and perhaps termination for the employee.

Thank you for your response and kind assistance.

How long have you know the applicant?	(Required)
In what capacity?
Would you re-hire this person?
If no, for what reason?

Please rate the applicant on the following characteristics:
Maturity compared to peers
Enthusiasm/Energy
Initiative/Motivation
Leadership
Tolerance/Patience
Honesty
Responsibility
Dependability
Personal Appearance
Humor
Communication
Team Player
Ability to take direction/guidance
Judgment
Flexibility/Adaptability
Understanding the needs of children
Social Acceptability (response from others)
Work Ethic (promptness, dependability)
Ability to work/live in a structured environment with rules, regulations/restrictions (smoking, alcohol, curfew)
Overall

Would you feel comfortable having the applicant be responsible for your child?
What weaknesses have you observed in the applicant?
What strengths have you observed in the applicant?
What words best describe the applicant?
Has the applicant ever had any criminal convictions for child abuse or sexual abuse offenses?
To the best of your knowledge, has the applicant ever had any criminal convictions for a felony?
Would you have any hesitation in allowing this applicant to be in a living situation (24hr/day) with your or anyone�s children?

If yes, please explain:
Your overall recommendation:
Your Full Name
Your Email Address
School or Business
Address
Daytime Phone Number
Evening Phone Number