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REFERENCE QUESTIONNAIRE
APPLICANT INFO:
Name of Applicant:
*
Which option best describes your relationship to the applicant?
*
Pastor or Christian Worker
Employer/Teacher
Friend
Other
OBJECTIVE RATING:
Under each general heading, check the phrase that most accurately describes the applicant's habitual behavior with regard to that specific trait.
How well is the applicant able to direct and influence others?
*
Poor leader; incapable of directing others
Usually follows the lead of others
Normally successful in directing and leading others
Very successful in leading others
Exceptional leader; inspires others
How well does the applicant work with others?
*
Cooperates grudgingly; makes trouble; obstructionist
Limited cooperation; neglects common good for own interests
Cooperates with others towards accomplishment of goals
Exceptionally successful working with others/inspires confidence
How does this person react to suggestions or criticisms by others?
*
Takes criticism as a personal insult; resents suggestions
Listens to suggestions but may act without considering them
Follows suggestions willingly
Asks for criticisms and suggestions
How does the applicant demonstrate a lifestyle committed to spiritual growth and integrity?
*
Fails to carry out convictions under stressful conditions
Acts according to convictions in most situations
Carries out principles and convictions constantly and boldly even in the face of obstacles
How responsible is the applicant?
*
Irresponsible even under supervision
With constant supervision will do a satisfactory job
Needs detailed instructions with regular checks of work
Carries out routine activity on own accord
Exceptionally able to accomplish work without close supervision
How well does this person apply energy and persistence in completing a task?
*
Needs much prodding to complete work
Rather indifferent; does not finish the job
Completes assigned tasks of own accord
Exceptional perseverance; does more than expected
How well does the applicant control their emotions?
*
Easily depressed, irritated or elated
Occasionally unresponsive
Unresponsive; apathetic
Tends to be overly emotional
Usually well-balanced
Well-balanced
APPLICANT EVALUATION:
With "1" as the lowest or poorest end of the scale and "10" as the highest or best, please select the number that best reflects this applicant.
Poor: 1-2, Average: 3-5, Good: 6-8, Superior: 9-10
Teachability
*
1
2
3
4
5
6
7
8
9
10
Promptness
*
1
2
3
4
5
6
7
8
9
10
Ability to Follow Instructions
*
1
2
3
4
5
6
7
8
9
10
Outgoing
*
1
2
3
4
5
6
7
8
9
10
Emotional Balance
*
1
2
3
4
5
6
7
8
9
10
Ability to Work With Children
*
1
2
3
4
5
6
7
8
9
10
Ability to Work With Youth
*
1
2
3
4
5
6
7
8
9
10
Fulfilling Obligations
*
1
2
3
4
5
6
7
8
9
10
Sense of Humor
*
1
2
3
4
5
6
7
8
9
10
Temper Control
*
1
2
3
4
5
6
7
8
9
10
Ability to Follow Through
*
1
2
3
4
5
6
7
8
9
10
Ethusiasm
*
1
2
3
4
5
6
7
8
9
10
Trustworthiness
*
1
2
3
4
5
6
7
8
9
10
Ability to Get Along With Others
*
1
2
3
4
5
6
7
8
9
10
Tactfulness
*
1
2
3
4
5
6
7
8
9
10
Leadership Ability
*
1
2
3
4
5
6
7
8
9
10
Friendliness
*
1
2
3
4
5
6
7
8
9
10
Willingness to Serve Others
*
1
2
3
4
5
6
7
8
9
10
QUESTIONS:
Please briefly state specific instances in which you have observed the applicant's behavior as it applies to any of these items. If you lack personal knowledge on a given topic, please say so.
How long have you known the applicant and in what capacity?
*
What special abilities does the applicant possess that would be valuable to Cedar Canyon Camp?
*
Is there anything in the personal life of the applicant that would disqualify him/her from serving at Cedar Canyon Camp?
*
Would you want the applicant to be a role model for your child?
*
Maturity of judgment. How does this person react in stressful situations, i.e. making decisions?
*
Dependability. Can he/she be relied upon? Does this person weaken in absence of supervision?
*
From your observation of the applicant, please list their three strongest points.
*
From your observation of the applicant, please list their three weakest points.
*
Please provide any additional comments that you feel will help us consider this applicant.
*
Please select one:
*
I recommend this person for a position at Cedar Canyon Camp
I do not recommend this person for a position at Cedar Canyon Camp
Your Name
*
Organization
Title
Phone
*
Email Address
*
Signature:
*
clear
Date:
*
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If you have any further questions or concerns regarding this reference form, please call the office at (605) 343-4394 or email our Director, Ben Sutton, at director@cedarcanyoncamp.com.
Thank you very much!