Employer Reference Form

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Employee Reference for:*

First Name Last Name
The 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? *

YesNo
6. 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*
Dependability*
Leadership*
Creativity*
Sensitivity*
Tolerance*
Communication*
Enthusiasm*
Manners*
Cooperation*
Team Player*
Follows instructions*
Seeks advice when necessary*
Works independently (without constant supervision)*
Punctuality*
Uses vacation, personal & sick time responsibly*
Overall performance of tasks*
To 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:*

Month Day Year
Reference Printed Name: *
Company Name:

Reference Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Reference phone #: *

Area Code Phone Number
I can be called between *
Should be Empty:

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