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...my help comes from the Lord! ~Psalm 121:1-2

Personal Reference Form

Please complete this reference as accurately as possible with information regarding the applicant. Thank you.

Name of Applicant *

First Name

Last Name

Position applied for *

To Be Completed by Reference

Your Name *

First Name

Last Name

Email Address

How long have you known the applicant? *

What is your relationship to the applicant? *

CMMBC strives to accept workers who are trustworthy, capable of caring for and discipling our campers, and who live as followers of Christ. Your honest and prompt response is appreciated. Place a check in the appropriate box below:

Spiritually Mature *

unknown

immature

minimal growth

growing

consistent growth

Christ-like Lifestyle *

unknown

inconsistent attitudes/practices

lifestyle consistent with beliefs

high moral/spiritual values evident

role model for others

Motivation *

unknown

needs prodding

meets timelines

self starter

finds additional tasks to do

Leadership ability *

unknown

passive

negative influence

well balanced

contributes positively

leader of leaders

Decision Making *

unknown

hasty

indecisive

fair decisions

good decisions

wise decisions

Honesty/Integrity *

unknown

questionable

may stretch the truth

generally honest and true

consistently trustworthy

Cooperation *

unknown

unable to cooperate

minimally cooperative

reasonably cooperative

extremely cooperative

Work Habits *

unknown

lazy

works enough to get by

puts in a fair day's work

puts forth extra effort

Social Interactions *

Unknown

avoided by others

socially awkward

tolerated by others

liked by others

example for others

Personality *

unknown

withdrawn

needy

quiet

shy

friendly

like-able

extroverted

fun-loving

Teachability *

unknown

resistant or disrespectful

questions authority

respectful

accepts and seeks good guidance

Rebellious *

unknown

often apparent

sometimes apparent

rarely apparent

never apparent

Argumentative *

unknown

often apparent

sometimes apparent

rarely apparent

never apparent

Rude *

unknown

often apparent

sometimes apparent

rarely apparent

never apparent

Critical attitude *

unknown

often apparent

sometimes apparent

rarely apparent

never apparent

Anxiety *

unknown

often apparent

sometimes apparent

rarely apparent

never apparent

Positive attitude *

unknown

poor

average

good

excellent

Sense of Humor *

unknown

poor

average

good

excellent

Temper Control *

unknown

poor

average

good

excellent

Tact *

unknown

poor

average

good

excellent

Dependability *

unknown

poor

average

good

excellent

Enthusiasm *

unknown

poor

average

good

excellent

Flexibility *

unknown

poor

average

good

excellent

Promptness *

unknown

poor

average

good

excellent

Rapport with kids *

unknown

poor

average

good

excellent

Rapport with adults *

unknown

poor

average

good

excellent

Creativity *

unknown

poor

average

good

excellent

Humility *

unknown

poor

average

good

excellent

If you had a child of camper age, would you feel comfortable leaving your child in the care of the applicant? Why or why not? *

Do you have any reason to believe that this applicant is not fit to work in close contact with or individually supervise children? If yes, please explain. *

Please check the following statement that most closely agrees with your recommendation for this applicant: *

I would recommend the applicant because I think that they will be an asset to the camp staff.

I would recommend the applicant because I think there will be an equal benefit to them and to the camp.

I would recommend the applicant because I think the camp experience will help them.

I would not recommend the applicant.

E-Signature *

Thank you for submitting your reference.

Covenant Mtn. Mission

Horse Hollow Road,

Jonesville, VA, 24263,

United States

276-346-1013 cmmbc1950@gmail.com

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Covenant Mtn. Mission | 2390 Horse Hollow Road | Jonesville, VA, 24263
276-346-1013 | cmmbc1950@gmail.com