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Applicant’s name:  (Required)

The person named above has applied for a position as a counselor in our co-educational children’s camp. Your critical appraisal and confidential evaluation of this person will be of great help in selecting our staff.

It is most important for leaders of boys and girls to be of high ideals, possess integrity, get along well with others in the intimate life of camp, be attractive to children and demonstrate a willingness to do more than "his or her share."

A counselor’s summer involves living and working with children between the ages of 7 to 15 for seven weeks. The counselor is with the children during the day, then sleeps in the same cabin with a group of children at night. Because living with children is very wearing, and because counselors live in close proximity to the campers, the experience is demanding.

We would appreciate your providing confidential information about the applicant. On a number of occasions we find it necessary to hire on the basis of information supplied by references and statements made by the applicant. Therefore, we hope you will be quite frank, candid and objective so that we may avoid mistakes that could result in a serious inconvenience for us and perhaps termination for the employee.

Thank you for your response and kind assistance.

How long have you know the applicant? (Required)

In what capacity?

Would you hire / re-hire this person?

If no, for what reason?

Is this the type of person you would want as a counselor for a child of your own?

Please explain if the answer is no:

Motivation (Desire to learn)
Emotional Maturity (self-control)
Social Acceptability (response from others)
Social Attitude (concern for others)
Understanding Children
Ability to Accept Supervision & Guidance

What are this applicant's greatest strengths? Weaknesses? What extra-curricular activities are they involved with?

To the best of your knowledge:

Has the applicant ever had any criminal convictions for child abuse or sexual abuse offenses?

Has the applicant ever had any criminal convictions for a felony or misdemeanor?

Your Full Name

Your Email Address

School or Business


Daytime Phone Number

Evening Phone Number