Name of Applicant

has applied for a position as Counselor Nurse Support Staff Other     Other 

1. What is your relationship to the applicant?

  Employer Supervisor Co-Worker Teacher/Professor Friend Other   Other 

2. How long have you know this applicant?

  Less than a year Between 1 and 3 years More than three years

3. Does the applicant have the stamina to withstand a dynamic and intense summer with only one day off per week?

  Yes No Maybe Please explain

4. Do you know of any limitations that might hinder this person’s working relationships with youth or adults?

5. Is this person appropriate to supervise, lead, work and play with children in an overnight setting camp?

  Yes No If needed please explain

6. What are the applicant abilities to work and or play with young children?

7. How would you rate this person’s maturity, motivation, initiative and judgment?

Maturity   Very High High Average Low Motivation   Very High High Average Low
Initiative Very High High Average Low Judgement  Very High High Average Low

8. Please give an overall rating of this person

  One of the best Very Good Good Do Not Hire

9. What are this persons religious and/or spiritual and/or philosophical believes that would help her or him be a great counselor at a youth Quaker camp

10.  Please give us over assessment of this persons strengths and weaknesses

Your Name

  (Required)

Title

Phone Number

E-mail Address

  (Required)

Signature

Date

Please return to:

Nat Shed, Director, Friends Camp
25 Burleigh Street
Waterville, ME 04901 USA
(207) 873-3499 or in the summer (207) 445-2361
E-mail: director@friendscamp.org