Fun, Family and Friends Forever - What Blue Rill is All About

Staff Reference Form

Welcome to Blue Rill Staff 2012!

Please take a moment to fill out and submit the following reference form. If you prefer to send it to us via mail, you can also download the form here.

Please be advised that we may be in contact with you to verify this reference. Thank you for your help. All fields below are required.

Blue Rill Applicant’s Name:	*
Your Name:
Title:
Email:
Best Phone # to reach you:
Address:
Your relationship to the applicant:
How long have you known him/her?
Have you seen the applicant work with children? If so, under what circumstances? Please describe what you have observed.
Working at camp is physically and emotionally demanding. Please discuss how you feel the applicant will manage in a challenging situation.

Please review the following and rate how well the applicant demonstrates each quality by checking the corresponding number:

	Poor				Excellent
Judgment	1	2	3	4	5	N/A
Cooperation	1	2	3	4	5	N/A
Responsibility	1	2	3	4	5	N/A
Relating with Children	1	2	3	4	5	N/A
Leadership	1	2	3	4	5	N/A
Working Well with Others	1	2	3	4	5	N/A
Taking Initiative	1	2	3	4	5	N/A
Reliability/Dependability	1	2	3	4	5	N/A
Flexibility	1	2	3	4	5	N/A
Enthusiasm	1	2	3	4	5	N/A
Creativity	1	2	3	4	5	N/A
Professionalism	1	2	3	4	5	N/A
Effectiveness at Duties	1	2	3	4	5	N/A
Friendliness	1	2	3	4	5	N/A
Uses Common Sense	1	2	3	4	5	N/A

How likely would you be to hire/rehire the applicant?
very somewhat unsure unlikely not applicable

Would you want the applicant to be your child’s counselor?
very somewhat unsure unlikely not applicable

Please enter any additional comments you feel are pertinent to the applicant.