Reference Form Reference Form Reference Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Reference Type *— Select Choice —Volunteer ReferenceReborne Rangers RecommendationLift & Team ReferenceSummer Staff ReferenceReborne Ranger Nominee *FirstLastApplicant Name *FirstLastApplicant Desired Position *The above named applicant has applied for a summer staff position at Lake Ann Camp. The Lake Ann Camp style of camping involves a great deal of hands on contact between staff and campers. We have a very serious attitude about the type of staff that we hire. They must be able to show a consistent godly attitude even under adverse circumstances. Thank you for conscientiously helping us to select those people who can consistently impact the young people entrusted to our care. Referent Name *FirstLastReferent Email *Referent Phone *Referent Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeReferent Occupation *Referent Employer *How long have you known the applicant? *In what capacity? *How well do you know the applicant? *— Select Choice —Very WellWellCasuallyQualifications Please answer the questions below. Responsibility *— Select Choice —Excellent – diligently follows through on tasksGood – follows through on tasksAverage – usually follows through on tasksPoor – needs to be told what to doInitiative *— Select Choice —Excellent – will look for things to doGood – will do things that need to be doneAverage – will do the obvious if there is needPoor – needs to be told what to doIndustry *— Select Choice —Excellent – puts forth the extra for excellenceGood – will put in a fair day’s workAverage – works enough to get byPoor – lazyLeadership *— Select Choice —Excellent – a leader of leadersGood – contributes positivelyAverage – usually well-balancedPoor – passive, observing and indifferent; negatively influencesEmotional *— Select Choice —Excellent – Articulate and manage emotions well with displayed empathy for othersGood – Can articulate and manage their emotions wellAverage – generally handles emotions wellPoor – does not handle emotions wellJudgment *— Select Choice —Excellent – consistently makes wise decisionsGood – makes good decisions in most situationsAverage – makes good decisions in optimal situationsPoor – hasty or indecisiveMotivation *— Select Choice —Excellent – exceptional stable and consistentGood – well-balanced in most situationsAverage – usually well-balancedPoor – excitable or unresponsiveCooperation *— Select Choice —Excellent – deeply sensitive to others, to allGood – generally concerned for others, to mostAverage – cooperates when it is convenientPoor – difficult to work withIntegrity *— Select Choice —Excellent – consistently trustworthyGood – generally honest and trueAverage – honest, but may stretch the truthPoor – questionable at timesPersonable *— Select Choice —Excellent – sharp, excellent first impressionGood – well-groomed, good first impressionAverage – gives an average first impressionPoor – neglects fine detail, sloppy the about would Communication *— Select Choice —Excellent – articulate, communicates to all groups clearlyGood – communicates well with most groups of peopleAverage – gets the thought acrossPoor – difficultly in articulating thoughts, needs to be told what to doStress *— Select Choice —Excellent – thinks well under pressureGood – able to make wise decisions under pressureAverage – reasonably calm under pressurePoor – abandons responsibility under pressureSociabilitySociability — Gregarious, known by allAnalytical — reflective, contemplativeWithdrawn — a lonerConfident — self-assuredBlunt and up frontTentative — self-consciousSteady — consistentAmiable — loyal, devoted, friendlyTimid and shyBrash and arrogantHard to readEntertainingPlease mark all which apply to the applicant.What do you consider special about the applicant? *How would you describe the applicant's relationship with God? *If my child were attending Lake Ann Camp this summer, the applicant as a support worker would be *— Select Choice —My first choiceA good choiceA concern to meA poor choiceI think a summer at Lake Ann Camp would be (choose the most appropriate answer) *— Select Choice —Great for this applicantGreat for the campers who attendCommentsI prefer to discuss this on the phoneYes, please call meSignature * Clear Signature Submit
