Arlene Streisand's
Summer Camp Services
P.O. Box 196
Jericho, NY 11753
1-800-443-6428 • • • 516-433-8033
Fax: 516-933-7949

PRINT THIS Recommendation Form FIRST!
Two references are required
When completed fax to: 516-933-7949

Reference for:______________________________

Who has applied to us for the position of:_________________________

Since we wish to engage people with proven ability and emotional stability, we would greatly appreciate your frank opinion. If you do not know the applicant in a camp setting, answer the questions below from your own frame of reference. We wish to thank you for your kind cooperation and assure you that your information will be held in the strictest confidence.

 

Superior

Average

Poor

Ability to teach above listed skill ___Hi ___Low ___Hi ___Low ___H i___low
Warmth and liking to children ___Hi ___Low ___Hi ___Low ___Hi___Low
Understanding of needs of children ___Hi ___Low ___Hi ___Low ___Hi ___Low
Ability to be fair - not partial ___Hi ___Low ___Hi ___Low ___Hi ___Low
Imagination and enthusiasm ___Hi ___Low ___Hi ___Low ___Hi ___Low
Ability to get along with people ___Hi ___Low ___Hi ___Low ___Hi ___Low
Health, energy and endurance ___Hi ___Low ___Hi ___Low ___Hi ___Low
Ability to accept responsibility ___Hi ___Low ___Hi ___Low ___Hi ___Low
Adaptibility to structure ___Hi ___Low ___Hi ___Low ___Hi ___Low
Willingness to learn ___Hi ___Low ___Hi ___Low ___Hi ___Low
Reaction of people to applicant ___Hi ___Low ___Hi ___Low ___Hi ___Low
Personal appearance ___Hi ___Low ___Hi ___Low ___Hi ___Low
Maturity compared to peers ___Hi ___Low ___Hi ___Low ___Hi ___Low

To the best of your knowledge has the applicant ever been investigated for allegations of child abuse?_________________________________________________________________

To the best of your knowledge has the applicant ever been convicted of a felony or misdemeanor which resulted in imprisonment?________________________________________________

How do you know applicant?_________________________________________________

________________________________________________________________________

Your Name (Please Print)____________________________________________________

Position:_______________________Organization:________________________________

Signature:____________________________Phone: ______________________________

Additional comments on back would be helpful. Thank you.

This reference form should be completed by a former employer, coach, teacher or other professional, NOT be a roommate, friend, neighbor, etc.


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