Staff Reference Form

About the Applicant

(*) Indicates required fields

Applicant's Name:*

How long have you known the applicant?*

In what capacity?

Would you hire/re-hire this person?

If no, for what reason?

Is this the type of person you would want as a counselor for a child of your own?

Please explain if the answer is no:

Motivation (Desire to learn):

Enthusiasm:

Loyalty:

Emotional Maturity (self-control):

Social Acceptability (response from others):

Tolerance:

Energy:

Responsibility:

Communication:

Social Attitude (concern for others):

Humor:

Understanding Children:

Leadership:

Ability to Accept Supervision & Guidance:

Summary:

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?

To the best of your knowledge, has the applicant ever had any criminal convictions for a felony or misdemeanor?

Your Full Name:*

Email Address:*

School or Business:

Address:

Daytime Phone Number:

Evening Phone Number: