Online Reference Form

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 working with children between the ages of 3 and 14 for eight weeks. The counselor is with the children from 9am to 5pm. Because lively children are very wearing, and because counselors work in close proximity with campers, the experience is demanding.

We would appreciate your providing us 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.

Your speedy reply will be greatly appreciated.

Thank you for your response and kind assistance.

Click here if you prefer to download this form in PDF format (70k), print and mail back to Woodmont Day Camp.

How long have you known 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