Camp Romaca

The applicant named below has applied for a staff position with our summer camp. Your honest appraisal of the applicant will assist us in determining if this person is suitable to participate in our camp’s program. Please note this reference is required under Massachusetts General Law for both new and returning staff members.

As a staff member, the applicant will be required to teach, lead and act as a role model for a group of children between the ages of six and sixteen. The staff member's primary responsibility is to ensure the children’s safety and well-being, and further to help make the children’s camp experience fun and rewarding. The applicant must possess responsibility, flexibility, a sense of humor, and a high level of moral integrity.

Because of the important responsibilities surrounding a program involving children, your honest appraisal and objective assessment of the candidate is of the utmost importance. The information you provide is greatly appreciated and will remain strictly confidential. Please note; we are unable to accept references from family members, relatives or friends.

We may contact you in the future if we need to verify any further information. Thank you in advance for your cooperation.

(*) Indicates Required Fields

Name of Applicant*

Performance Evaluation
Please check the items for which you have sufficient knowledge about the applicant:

Integrity
Work habits/organization
Adaptability/flexibility
Attitude
Relationship with co-workers
Leadership abilities
Ability to work in groups
Responsibility
Ability to relate to children
Children’s response to applicant
Maturity
Perseverance

Objective Rating
Please check the items for which you have sufficient knowledge about the applicant:

Ability to direct and influence others:	Exceptional leadership qualities Usually successful in leading others Unreliable leadership qualities
Ability to relate to and give guidance to children:	Children naturally get along very well with applicant Children adequately participate Children often ignore instruction
Ability to control emotions:	Well balanced, good control Average ability to control emotions Frequently irritated, impatient or depressed
Ability to work and cooperate with others:	Gets along exceptionally in groups-a team player Will cooperate in most circumstances Gives limited cooperation-better suited to solitary work
Ability to follow through with job assignments:	Completes tasks promptly, often does more than expected Completes assigned tasks at own pace Needs constant supervision to complete work
How would you rate the applicant as a role model for children:	Excellent Very Good Fair Poor

Would you be willing and completely comfortable leaving your children under the applicant’s supervision? Please explain:

Does the applicant show signs of any behavior which would cause concern when working directly with children?

How long have you known the applicant and in what capacity?

Please comment on the applicant’s suitability for this camp program.

Name of referee*
Address
Phone*
Company
Position/Title
Email*
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