Employee Reference for:*First NameLast NameThe above named individual has applied to become a camp counselor. Summer camp & child care is provided here for children ages 3-10 years old, licensed by Nassau County Dept of Health. (S)he has given your name as an EMPLOYEE reference. Please complete the following reference form and return it to this office at your earliest convenience by fax or mail.1. How long was the applicant employed by you?*2. What was the nature of the job?*3. Discuss the experience required for this job:*4. How would you describe the applicant’s relationship with his/her co-workers?*5. Would you rehire this person to work for you?*YesNo6. From your knowledge, how well does he/she relate to children?*Areas of strength:*Areas of weakness:*Please rate the applicant on the following merits:Character*OutstandingVery GoodGoodFairLowN/ADependability*OutstandingVery GoodGoodFairLowN/ALeadership*OutstandingVery GoodGoodFairLowN/ACreativity*OutstandingVery GoodGoodFairLowN/ASensitivity*OutstandingVery GoodGoodFairLowN/ATolerance*OutstandingVery GoodGoodFairLowN/ACommunication*OutstandingVery GoodGoodFairLowN/AEnthusiasm*OutstandingVery GoodGoodFairLowN/AManners*OutstandingVery GoodGoodFairLowN/ACooperation*OutstandingVery GoodGoodFairLowN/ATeam Player*OutstandingVery GoodGoodFairLowN/AFollows instructions*OutstandingVery GoodGoodFairLowN/ASeeks advice when necessary*OutstandingVery GoodGoodFairLowN/AWorks independently (without constant supervision)*OutstandingVery GoodGoodFairLowN/APunctuality*OutstandingVery GoodGoodFairLowN/AUses vacation, personal & sick time responsibly*OutstandingVery GoodGoodFairLowN/AOverall performance of tasks*OutstandingVery GoodGoodFairLowN/ATo your knowledge, has the applicant suffered any significant physical or nervous difficulties which would interfere with his/her work with children or staff?*Would you want this person hired for the position he/she is being offered at Gan Israel? Why or why not?*Reference Signature:*Date:*1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberMonth12345678910111213141516171819202122232425262728293031Day2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920YearReference Printed Name:*Company Name:Reference Address*Street AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNagorno-KarabakhNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandTurkish Republic of Northern CyprusNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTransnistria PridnestrovieTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountryReference phone #:*Area CodePhone NumberI can be called between*SubmitShould be Empty: This page uses TLS encryption to keep your data secure.