Cheley Staff Reference Questionnaire

To provide the highest quality staff at our summer camp for children, Cheley needs your help. The applicant states that they were known by you. We would appreciate it if you would answer the following questions, and we assure you that your answers will be held in strict confidence. Please do not complete if you are related to the applicant. Thank you.

Please indicate the type of reference that you are giving:

Work/volunteer

Character/personal

First Name of Person You are Completing Reference For:

Last Name:

How long have you known the applicant?

In what capacity?

Reason for leaving?

Would you rehire?

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

	Excellent	Very Good	Acceptable	Needs Improvement	N/A or Not Seen
Honesty/integrity
Adaptability/flexibility
Maturity/judgement
Co-Worker Relationships
Work habits and organization
Ability to be a team member
Care and compassion for children
Energy/enthusiasm
Personal hygiene/appropriate attire

1. Ability to direct and influence others:

Exceptional leadership qualities

Usually successful in leading others

Unreliable leadership qualities

N/A or Not Seen

2. Ability to work and cooperate with others:

Gets along exceptionally well in groups: a team player

Will cooperate in most circumstances

Gives limited cooperation – better suited to solitary work

N/A or Not Seen

3. Ability to control emotions:

Well balanced, good control

Average ability to control emotions

Frequently irritated, impatient, or depressed

N/A or Not Seen

This applicant is best suited for:

direct work with children

a support role

either direct work with children or a support role

Comments
Please add any comments that would help us know the applicant's suitability for work around children?

Contact Information

Your First Name:

Last Name:

Company:

Title:

Address:

City:

State:

Zip:

Phone:

Email:

I confirm that the above statements are true and accurate to the best of my knowledge.