EmailMeForm
Camp Shalom Summer Staff Reference Form
Thank you very much for taking the time to fill out the form below. Since it is our purpose to secure an understanding of the candidate's personality as a whole, we urge you to be completely frank, in justice both to the person under consideration and to us. Feel free to offer pertinent facts and judgements not covered by the questionnaire. Please do not withhold anything favourable or unfavourable that will enable us to assess the candidate's qualifications for Christian service with potentially vulnerable persons.
Your Name (Referee)
*
First
Last
Phone Number
*
###
-
###
-
####
Email
Reference For (Applicant's Name)
*
First
Last
How long and under what circumstances have you known the candidate?
*
What do you believe are the applicant’s reasons for applying to “Camp Shalom”?
*
Give any information you can regarding the candidate's church involvement or Christian service activities.
*
To the best of your knowledge has the candidate been: 1) involved in any criminal activity including, but not limited to sexual offences 2) accused of improper sexual contact with children or minors?
*
Yes
No
Not Sure
Have you known the candidate to exhibit any of the following tendencies? Please check any that apply.
*
Impatient
Intolerant
Argumentative
Domineering
Conceited
Easily embarrassed
Depressed
Anxious
Nervous or tense
Prejudiced towards groups, races or nationalities
Given to exclusive and absorbing friendships, i.e. to "crushes"
Lacking in humour, or in the ability to take a joke
None of the Above
Please put any additional notes on any of these in the summary section at the end of the form.
In your judgement does the applicant have a good grasp of Biblical concepts
*
Yes
No
Average
Not Sure
Sound Christian Beliefs
*
Yes
No
Average
Not Sure
Exemplify a moral lifestyle
*
Yes
No
Average
Not Sure
Please Rate the Followoing to the Best of Your Ability
Physical Condition
*
Excellent
Good
Average
Poor
Not Observed
Socially Adept
*
Excellent
Good
Average
Poor
Not Observed
Ability To Think ‘On Their Feet’
*
Excellent
Good
Average
Poor
Not Observed
Pleasant Personality
*
Excellent
Good
Average
Poor
Not Observed
Ability To Formulate & Execute Plans
*
Excellent
Good
Average
Poor
Not Observed
Ability to Inspire Others & Maintain Confidence
*
Excellent
Good
Average
Poor
Not Observed
Ability to Work in a Team
*
Excellent
Good
Average
Poor
Not Observed
Self Discipline
*
Excellent
Good
Average
Poor
Not Observed
Soundness of Judgement
*
Excellent
Good
Average
Poor
Not Observed
Self-Knowledge (of strengths/weaknesses)
*
Excellent
Good
Average
Poor
Not Observed
Quality of Work
*
Excellent
Good
Average
Poor
Not Observed
Ability to be a Self-Starter
*
Excellent
Good
Average
Poor
Not Observed
Dependability
*
Excellent
Good
Average
Poor
Not Observed
Punctuality
*
Excellent
Good
Average
Poor
Not Observed
Responsiveness to Feelings of Others
*
Excellent
Good
Average
Poor
Not Observed
Integrity
*
Excellent
Good
Average
Poor
Not Observed
Emotional Stability
*
Excellent
Good
Average
Poor
Not Observed
Ability to Adapt to Changes
*
Excellent
Good
Average
Poor
Not Observed
Christian Witness
(sharing faith through word & action)
*
Excellent
Good
Average
Poor
Not Observed
Spiritual Discipline (e.g.: prayer/devotions)
*
Excellent
Good
Average
Poor
Not Observed
Leadership Skills
*
Excellent
Good
Average
Poor
Not Observed
Desire to Serve
*
Excellent
Good
Average
Poor
Not Observed
Ability with Campers Grades 1-3
*
Excellent
Good
Average
Poor
Not Observed
Ability with Campers Grades 4-6
*
Excellent
Good
Average
Poor
Not Observed
Ability with Campers Grades 7-9
*
Excellent
Good
Average
Poor
Not Observed
Ability with Campers Grades 10-12
*
Excellent
Good
Average
Poor
Not Observed
Ability with Persons who have Developmental Challenges (Sensitivity… Responsibility…)
*
Excellent
Good
Average
Poor
Not Observed
Summary Section
Overall, how do you rate the candidates promise for serving in camp ministry?
*
Excellent
Good
Average
Poor
Should be Discouraged
Summary paragraph: Please state frankly your opinion of the candidate's all-around fitness for Christian service, adding any significant information and impressions which have not been brought out by the preceding questions.
Thank you very much for filling out this reference form. All of your answers will be kept strictly confidential.
If a confirmation note does not appear after you click "Submit Reference," scroll up to see if you filled in all of the required fields. It will take a few seconds to load.
