Applicant's Name* First Name Last Name The person named above has applied for a position in our children's summer camp. Your critical appraisal and confidential evaluation of this person is extremely helpful in our staff selection process.If the applicant has applied to be a Camp Counselor with us, their summer involves living and working with children between the ages of 7 to 16 for seven weeks. A camp counselor is with the children during the day and sleeps in a cabin with a group of children at night. Since living with children is very exhausting, and counselors live in close proximity to the campers, the experience can be quite demanding. As a Program Leader or Coach the applicant will have additional responsibilities of supervising staff.If the applicant has applied to work as a member of our Support Team (nurse, office, food service, housekeeping, laundry, operations, driver, or maintenance), they will be working with children and living with other staff with very little privacy.We would appreciate you providing confidential information about the applicant. We often 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 can protect the safety of our campers and avoid situations that could result in termination for the employee.Thank you for your response and kind assistance.How long have you known the applicant?*In what capacity?*Would you hire / re-hire this person?YesNoNot ApplicableIf no, for what reason?Is this the type of person you would want as a counselor for a child of your own?YesNoPlease explain if the answer is no:Would you hire / re-hire this person to work with a child of your own?YesNoNot ApplicableIf no, for what reason?Motivation (Desire to learn)--- Select One ---Very ambitiousEagerAverageIndifferentPurposelessEnthusiasm--- Select One ---ExcellentGoodAverageFairPoorLoyalty--- Select One ---ExcellentGoodAverageFairPoorEmotional Maturity (self-control)--- Select One ---Very StableWell-BalancedAverageBelow AverageUnstableSocial Acceptability (response from others)--- Select One ---Sought outWell-likedAcceptedToleratedAvoidedTolerance--- Select One ---ExcellentGoodAverageFairPoorEnergy--- Select One ---ExcellentGoodAverageFairPoorResponsibility--- Select One ---Always AssumesOften SeeksAcceptsAvoidsNever acceptsCommunication--- Select One ---ExcellentGoodAverageFairPoorConcern for Others--- Select One ---Deeply ConcernedInterestedAverageIndifferentAnti-socialHumor--- Select One ---ExcellentGoodAverageFairPoorUnderstanding Children--- Select One ---ExcellentGoodAverageFairPoorLeadership--- Select One ---Always leadsFrequently LeadsSeldom leadsFollowerNegativeAbility to Accept Supervision & Guidance--- Select One ---ExcellentGoodAverageFairPoorAppearance--- Select One ---ExcellentAbove AverageAverageSummary--- Select One ---OutstandingAbove AverageAverageFairDoubtfulWorking at camp is often physically and emotionally demanding. Do you think he/she will have any problems?*Work at camp often requires coping without much privacy. How do you think the applicant will deal with this?*What are this applicant's greatest strengths? Weaknesses? What extra-curricular activities are they involved with?*To the best of your knowledge:Has the applicant ever had any criminal convictions for child abuse or sexual abuse offenses?NoYesHas the applicant ever had any criminal convictions for a felony or misdemeanor?NoYesYour Full Name*Your Email Address* School or Business*Address Street Address City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Daytime Phone NumberEvening Phone NumberPrivacy*Your personal information is collected and used only to communicate with you in regards to this specific inquiry. 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