Camp Orchard Hill

Your Name

First NameLast Name

Applicant's Name

First NameLast Name

Church Name

Phone Number

Area CodePhone Number

All answers on this form will be kept confidential. Please answer honestly.

How long have you known the applicant?

How well do you know the applicant?

To the best of your knowledge, has the applicant made a personal commitment to Jesus Christ?

YesNo

Indicate the applicant's level of involvement in church functions.

Does not attend regularlyAttends regularly but shows little interestAttends regularly some participationAttends regularly and is actively involved

Describe the applicants abilities and talents

To your knowledge does the applicant

SmokeDrink alcoholUse illegal drugs

Does the applicant have habits or attitudes that are inconsistent with the Christian lifestyle? If yes, please explain.

The applicants spiritual influence on their peers is

PositiveNeutralNegative

How do you rate this person in the following areas... (1 is lowest, 5 is highest)

Leadership

	1	2	3	4	5

1 is Worst, 5 is Best

Responsibility

	1	2	3	4	5

1 is Worst, 5 is Best

Christian Commitment

	1	2	3	4	5

1 is Worst, 5 is Best

Initiative

	1	2	3	4	5

1 is Worst, 5 is Best

Cooperation

	1	2	3	4	5

1 is Worst, 5 is Best

Personal Hygiene

	1	2	3	4	5

1 is Worst, 5 is Best

Moral Character

	1	2	3	4	5

1 is Worst, 5 is Best

Health

	1	2	3	4	5

1 is Worst, 5 is Best

Social Adaptability

	1	2	3	4	5

1 is Worst, 5 is Best

Integrity and Honesty

	1	2	3	4	5

1 is Worst, 5 is Best

Emotional Stability

	1	2	3	4	5

1 is Worst, 5 is Best

Service to Others

	1	2	3	4	5

1 is Worst, 5 is Best

Relationship to Family

	1	2	3	4	5

1 is Worst, 5 is Best

Does the applicant have personality traits that impairs their relationship with others? If yes, please explain.

Would you hire this applicant?

Any additional things we should know about this applicant?

Signature

Pastoral Reference Form