age !

of "


#$%&'()%*'+, .)&).)%#)
Clrl ScouLs of norLheasL 1exas 6001 Summerslde, uallas, 1x 73232
972-349-2400 1-800-442-2260 lAx 972-349-2498


ls applylng for Lhe poslLlon of aL one of our camps
!"#$% '( #))*+,#"-. !/-#-% )'/+-+'".


/0110 20341 .4567 24891 :;<=8>> (please selecL approprlaLe camp) Lhls summer.


*4 1?0 203@49 #4<A>0189B 1?0 .0C030950D
1he success of our camplng program ls dependenL upon Lhe selecLlon of a quallfled, maLure sLaff. 1herefore, lL ls vlLal LhaL as
much lnformaLlon as posslble ls avallable Lo conslder appllcanLs. lease conslder each quesLlon carefully before respondlng.


1o help you compleLe Lhls form, we look for Lhe followlng ln our sLaff members:
$E03;>> All sLaff members llve ln an ouLdoor seLLlng for approxlmaLely nlne weeks worklng wlLh glrls beLween Lhe ages of 6
and 17.
234B3;< F1;CC LquesLrlan SLaff, AdvenLure SLaff, unlL Counselors, AssL. WaLerfronL ulrecLor, 8oaLlng SpeclallsL, rogram
SpeclallsLs, !unlor Counselors, Cl1s and Wl1s have Lhe dlrecL care and guldance of campers on a 24-hour basls. 1hese sLaff
members need Lo have an undersLandlng of Lhe campers needs and lnLeresLs, Lhe ablllLy Lo work wlLh chlldren, sound
[udgmenL, and emoLlonal maLurlLy.
FGA03E8@437 F1;CC 1he PealLh Supervlsor, unlL Leaders, WaLerfronL ulrecLor, AssL. Camp ulrecLor, Camp ulrecLor and
8uslness Manager are responslble for Lhe supervlslon of oLher sLaff members, Lhe smooLh operaLlon of dally camp acLlvlLles,
and Lhe healLh and welfare of campers and sLaff. 1hese lndlvlduals musL have admlnlsLraLlve skllls, work wlLh and supervlse
people effecLlvely, use sound [udgmenL, and be emoLlonally maLure. 1hey also need Lo have an undersLandlng of campers
needs and lnLeresLs and Lhe ablllLy Lo work wlLh chlldren.

Slnce all references musL be recelved before an appllcanL can be consldered, your lmmedlaLe aLLenLlon would be appreclaLed.
lease reLurn Lhe compleLed form Lo Lhe address above. All references are confldenLlal.
1. ln whaL capaclLy and how long have you known Lhe appllcanL?



2. Would you employ Lhls appllcanL for a poslLlon of leadershlp and responslblllLy? ?es no
Why or why noL?





3. 1he appllcanL wlll be worklng wlLh glrls/campers ages 6 Lo 17 on a 24 hour-a-day-basls. uescrlbe brlefly why you belleve Lhe
appllcanL could or could noL handle Lhls slLuaLlon:




age H of "



4. 1he camplng slLuaLlon calls for conLlnued close assoclaLlon wlLh oLher adulLs -- lncludlng co-workers and supervlsors. lL ls
lmporLanL LhaL Lhe appllcanL be able Lo work well wlLh peers and oLher adulLs and respond Lo supervlslon. ln whaL ways wlll
Lhe appllcanL conLrlbuLe Lo Lhe group?




3. uescrlbe brlefly how you feel Lhe appllcanL would reacL ln an emergency or unusual clrcumsLance:




6. 1he appllcanL wlll be requlred Lo assume responslblllLy and carry ouL asslgnmenLs wlLh a mlnlmum of supervlslon. 8ased on
your knowledge of Lhe appllcanL, how wlll he/she accompllsh Lhls?




7. WhaL problems mlghL Lhe appllcanL have as a camp member?




8. Would you enLrusL Lhe care of your chlldren Lo Lhe appllcanL on a 24 hour-a-day basls.



9. Pow would you raLe Lhe appllcanL as a poLenLlal camp sLaff member?

8elow Average Average Above Average LxcepLlonally SLrong


10. lf Lhe appllcanL was employed by you, please compleLe Lhe followlng:

oslLlon occupled by appllcanL:


uaLes employed:


8eason for LermlnaLlon/ or ellglblllLy for re-hlre:







age " of "


11. 1he assessmenL of Lhe followlng work-relaLed characLerlsLlcs & skllls ls very helpful as we conslder Lhe appllcanL. lf you do noL
have flrsL-hand knowledge of Lhe appllcanL's ablllLles ln any of Lhese areas please lndlcaLe ln Lhe approprlaLe box.

:)%).+, #I+.+#*).'F*'#FJ FK',,F

Lxceeds MeeLs 8elow unknown CommenLs
CooperaLlveness / 1eamwork
llexlblllLy
Sense of Pumor
PealLh, Lnergy, Lndurance
Appearance, Speech, Manner, CommunlcaLlon Skllls
ersonal lnLegrlLy
LmoLlonal MaLurlLy and SLablllLy
Sense of 8esponslblllLy
lnlLlaLlve
uependablllLy and rompLness
8esponslble ueclslon Maklng
Sound !udgmenL
Leadershlp AblllLles
Wllllngness Lo Learn and AdapL
Awareness of Chlldren's needs and lnLeresLs
AblllLy Lo Work wlLh Croups of Chlldren
AblllLy Lo Work wlLh Chlldren on an lndlvldual 8asls
AblllLy Lo Work wlLh AdulLs
AblllLy Lo AccepL Supervlslon
AccepLance of ConsLrucLlve CrlLlclsm
oslLlve ALLlLudes Loward persons of oLher races,
naLlonallLles, rellglons and soclo-economlc backgrounds

8esourcefulness
Self Confldence



name (please prlnL)) oslLlon

hone (h) ( ) (w) ( ) Lmall:

F8B9;1G30 uaLe