Girl Scouts of Colorado - Reference

Name of applicant: *

Name of reference: *

Your name has been given as a reference for someone applying for a position with one of Girl Scouts of Colorado resident camps. We are seeking responsible adults with a genuine interest in working with children. The nature of or program, which involves campers in planning and carrying out their own activities, requires responsible, mature staff who are creative, resourceful, and comfortable with strenuous outdoor living. They must be able to work well with others and live comfortably in a close, young-adult community for an extended period of time.

The task of selecting the right people for the important responsibilities of being role models and providing leadership for young children is difficult. We appreciate your help in assessing this applicant's qualifications.

As further action depends on your response, your prompt attention to this matter will be much appreciated. All of your statements regarding this applicant are confidential.

How long have you known the applicant?

In what capacity?

Have you seen the applicant work with children?

If so, under what circumstances?

Please describe what you have observed (include number and ages of children):

How does the applicant handle conflict?

How does the applicant handle stress?

Describe the applicant's emotional maturity:

Girl Scouts of Colorado takes a strong stand on smoking and a no-tolerance policy against the use of alcohol or illegal drugs when employed.

Do you feel that the applicant would have difficulty in adapting to and living with strict policies on these issues?

If yes, why?

Objective Rating

Under each general heading, check the phrase that most accurately describes the applicant's HABITUAL behavior with regard to specific traits.

1. How well is the applicant able to direct and influence others?

Usually follows the lead of others
Does not follow the lead of others
Normally successful in directing others
Exceptional leader: inspires others along desirable lines of action

2. How well does individual work with others for the good of the group?

Will cooperate in most circumstances
Limited cooperation - better suited to solitary work
Cooperates with others toward accomplishment of common cause
Exceptionally successful in working with others and inspiring confidence

3. How does this person react to suggestions or criticisms by others?

Defensive response
Listens to suggestions but may act without considering them
Follows suggestions willingly
Asks for suggestions

4. How responsible is the applicant? Are they able to work independently?

Sometimes doesn't complete tasks
Gets things done, but often last minute
Usually needs detailed instructions with regular checks of work
Carries out assigned activities on own responsibility

5. How well does this person apply energy and persistence in following a job through?

Needs much prodding to complete work
Rather indifferent: does not finish job on own
Completes assigned tasks on own
Industrious, energetic: dependable at all times

6. How does the applicant communicate?

Withdrawn
Has difficulty sharing with others
Listens effectively and expresses ideas in one-to-one situations
Listens effectively and actively participates in group discussions
Exceptional communicator in all situations

7. How would you rate the applicant as a role model for children?

Excellent
Very Good
Fair
Poor

Comments:

If you ran a summer camp and were looking to hire the very best in mature, dynamic, responsible camp counselors, would you hire this individual?

Why or why not?

In the event that we would like to contact you for further information regarding this applicant, please provide the following contact information.

Day phone number:

Other number:

E-mail:

By typing my name or initials on this form, I am entering my "eSignature" and certifying that I have read, fully understand and accept all terms of the document.

Date:

Signature:

Position: