Online Reference Form

One of your associates has applied for a position as a counselor at Camp La Junta this summer. We desire people with enthusiasm, energy, initiative, maturity, sensitivity and a superior ability to get along with both children and adults. Duties will include close contact with young people. Applicants will be put in a position as Role Model to impressionable 6 - 14 year olds. Because of the sensitivity and importance of a position working with young people, we would appreciate your candid opinion of this applicant. * All fields are required.
Name of applicant? *
How long have you know the applicant? *
In what capacity? *

Please evaluate these traits (all fields required)

 excellentgoodaveragepoor
Maturity
Loyalty
Dependability
Honesty
Initiative
Leadership
Ability to get along
Cooperation
Communication Skills
Patience
Concern for Others
Self-Confidence
Enthusiasm
Energy
Health
Teaching Ability
Appearance

Would you place your child under the leadership of this applicant? *

Do you know of any personal habits, behaviors, or other circumstances (drugs, alcohol, criminal history, past convictions with children) which would in your opinion disqualify the applicant for the position of guiding and instructing young boys? If yes please explain. *

We depend upon third party references in our decision process. Any further, more explicit comment you with to share below will be gratefully appreciated and kept in strictest confidence. *


Your general estimate * Hire   Hireable   Questionable  
Your name * Daytime phone * Respondent email *

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