Reference Form

Thank you for taking the time to fill out this personal reference form

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This reference form is to be completed by 3 references for each potential THS Faculty and potential Camp Bailey Counselors. The Hill School and Camp Bailey are Christian programs for students from birth to 6th grade. Our school faculty and summer counselors must have a love for children and a desire to teach them about Jesus. The above applicant has applied for a position as one of our staff members. With this in mind, please answer the following form to the best of your knowledge regarding the applicant. Please be as objective as possible. Your responses will not be shown to the applicant.

Employment Reference Form

Reference for(Required)

First Last

Nature of Relationship with Applicant

Family

Professional / Civic

Personal

How long have you known this person?(Required)

In what capacity(Required)

Do you know this person on a one-to-one basis or in a group context(Required)

If group, what size and type(Required)

Rate the Applicant

Please rate the applicant in the following categories on a scale of 1-10 (1 representing low, poor, or Never/ 10 representing high, best, or always). Select N/A if you are completely unsure or if you have no prior knowledge in a particular area.

Promptness(Required)

Follows Instructions(Required)

Policy Adherence(Required)

Fulfills Obligations(Required)

Follow-Through Ability(Required)

Emotional Self Control(Required)

Emotional Stability(Required)

Effective Stress Management(Required)

Self Image(Required)

Mental Alertness(Required)

Judgment(Required)

Maturity(Required)

Friendly(Required)

Integrity(Required)

Trustworthy(Required)

Outgoing(Required)

Able To Get Along With Others(Required)

Leadership Ability(Required)

Work With Children(Required)

Sense Of Humor(Required)

Servant-hearted(Required)

Temper Control(Required)

Tact(Required)

Teachability(Required)

Moral Character(Required)

Positive Attitude(Required)

Applicant’s relationship with Christ appears to be

Intimate

Growing

New

Not Apparent

Unable to comment

I expect the applicants response to authority to be(Required)

Superior

Good

Average

Poor

I expect the applicant's work to be(Required)

Superior

Good

Average

Poor

Additional Comments

I would describe the applicant’s personality as (check all that apply)

Comment on the applicants readiness and ability to lead(Required)

How much coaching/supervision will the applicant need to be successful?(Required)

To your knowledge, how does the applicant respond under difficult, stressful circumstances?(Required)

Is the applicant able to maintain strong, appropriate relationships with minors that are not mistaken by others as social or sexual in nature(Required)

Yes

What areas of the applicants life need development or attention?(Required)

THS's first priority is the safety and well-being of our students and staff members.

THS has ZERO TOLERANCE for child abuse and takes all allegations of abuse seriously.

To your knowledge, has the applicant ever been accused of physically, sexually, or emotionally abusing, molesting, or having otherwise inappropriate contact with a child or an adult(Required)

Yes

Comment

To your knowledge, has the applicant ever physically, sexually, or emotionally abused, molested, or had otherwise inappropriate contact with a child or an adult(Required)

Yes

Comment

If I had a camp-age child I _____ consider the applicant to be a good influence when in contact with my child(Required)

Yes

Comment

I _____ hire the applicant as a summer camp counselor/staff member(Required)

Would

Would Not

What specific reasons would you give for hiring or not hiring the applicant(Required)

About You

Name(Required)

First Last

Your Position(Required)

Your Phone Number(Required)

Email(Required)

The Hill School A Christian School in Fayetteville, AR

Reference Form

Thank you for taking the time to fill out this personal reference form

Employment Reference Form

Rate the Applicant

THS's first priority is the safety and well-being of our students and staff members.

About You

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