CAMP AKITA Reference Form

Reference Form
I am applying for a staff position with Camp Akita Summer Camp Ministries. Your frank appraisal will assist the director in evaluating my qualifications and abilities. When you have completed the form, please click submit. Thank you for your immediate response.
URGENT: Staff's application cannot be processed further until this form is submitted to us! Please submit NO LATER THAN March 15th.

If you have any question, please contact Illinois Conference Youth Department, email: youthdept@ilcsda.org or call: (630) 716-3555.
Please Choose: *

Pastor/Spiritual Leader Dean/Teacher Work Supervisor
Full Name *

First Name Last Name
Email *
Phone # *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
General Impression
Student's name: *

First Name Last Name
Select whichever you believe to be applicable.

1 = Excellent, 2 = Above Average, 3 = Average, 4 = Below Average, 5 = Poor.
Spiritual Influence *

1 2 3 4 5
Spiritual Commitment *

1 2 3 4 5
Attitude toward church structure, doctrines, standards *

1 2 3 4 5
Judgment *

1 2 3 4 5
Dependability *

1 2 3 4 5
Leadership Potential *

1 2 3 4 5
Cooperation *

1 2 3 4 5
Initiative and Resourcefulness *

1 2 3 4 5
Intellect *

1 2 3 4 5
Personality *

1 2 3 4 5
Work Ethic *

1 2 3 4 5
Adaptability *

1 2 3 4 5
Appearance *

1 2 3 4 5
Emotional Stability *

1 2 3 4 5
Communication *

1 2 3 4 5
Specific Qualities
Check all qualities that describe applicant.
*

Positive Role Model Passive Negative Dedicated Growing Searching Uncommitted Active Support Passive Acceptance Resistance Mature Discrete Adequate Inconsistent Consistant Erratic Poor Natural Talent Follower Obstructive Confident Imaginative Original Persevering Easily Discouraged Quick Average Slow to Grasp Material Extroverted Well-Balanced Introverted Egocentric Unselfish Easily Offended Hard Worker Accepts Criticism Diligent Focused Easily Distracted Slow On Time Flexible Open Minded Self-Confident Prejudiced Well-Groomed Relatively neat Careless Sloppy Stable
How long have you known the applicant? *
To the best of knowledge, has the applicant ever been convicted of a crime? *
If Yes, Explain:
Have you personally seen this person actually working with children or youth? *
If Yes, Explain:
What do you consider to be the applicant's most outstanding talent or characteristics? *
What would you consider as a possible weakness for the applicant in this context? *
Please give any further information, which would be helpful to the director in appraising the applicant. *
If you have a child, would you want this applicant to be his/her counselor for a week? *
Signature for Confirmation:

Clear
Additional Information
Selection Process:

1. Completed applications are compiled with returned recommendation forms.

2. Applications, recommendations forms and interview notes are considered as specific positions are filled.

3. Further recommendations may be sought from those acquainted with the applicant.

4. All applicants will receive a letter indicating one of these decisions:

a. Hired as a staff member.

b. Waiting list-due to cancellations and changes in plans. Positions may be available by summer.

c. Unable to be hired this summer.

5. Contracts will be sent to hired staff, prior to camp.
Should be Empty:

Reference Form

General Impression

Specific Qualities

Additional Information