Reference Form - Counselor/Op Staff

HHBC Reference Form

The contents of this form will be held in strict confidence and will not be shared with the applicant. Please answer honestly and thoroughly.
Name of Person Applying to serve at Camp*

First NameLast Name
Your Information
Your Name*

First NameLast Name
Email*
Your email address will be used for correspondence.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
You are:

the Pastor/Youth Pastor of the applicanta parent of the applicantanother adult reference
Applicant Information - written
How long and in what capacity have you known this applicant? *
In your opinion, is this applicant fully qualified to work with children and youth? *
Are you aware of anything in the applicant's background, personality, or behavior that could pose a threat to children or youth? *
List a few strengths you have seen this applicant display. *
List a few weaknesses you have seen this applicant display. *
Applicant information - scale

Please give additional information as needed in Notes section below.

CHARACTER - desires to do and does what is right, integrity*

	1	2	3	4	5

1 is Worst, 5 is Best

DEPENDABILITY - person of their word, punctual, follow-through*

	1	2	3	4	5

1 is Worst, 5 is Best

COOPERATION - obeys authority, submissive, receives correction*

	1	2	3	4	5

1 is Worst, 5 is Best

GENERAL INTELLIGENCE - common sense and scholastic ability*

	1	2	3	4	5

1 is Worst, 5 is Best

ABILITY TO GET ALONG WITH OTHERS - selflessness, humility, teamwork*

	1	2	3	4	5

1 is Worst, 5 is Best

RELATIONSHIP WITH FAMILY - on good terms, submissive, honoring*

	1	2	3	4	5

1 is Worst, 5 is Best

RELATIONSHIP WITH GOD - devotional life, consecration*

	1	2	3	4	5

1 is Worst, 5 is Best

Any Additional Comment or Explanations
"I certify that the information above is complete and true."
Signature

Clear
Date of Signature

MonthDayYear
Date
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HHBC Reference Form