BEAVER CREEK YOUTH CAMP

REFERENCE CHECK FORM

Staff Applicant: _______________________________________________________________________________

Reference Name: ______________________________________________________________________________

Reference Address: ____________________________________________________________________________

Reference Phone: __________________________________ Reference Email: ___________________________

Applicant has authorized release of information sought by this Reference Check. Applicant provided addressee's name as a possible source of information for this express purpose and any information disclosed by the addressee will be retained by the Camp Director and will be disclosed only to Rocky Mountain Annual Conference Camp Directors or person in charge of camps/events the applicant has applied for, for the sole and limited purpose of evaluating the applicant for the position as counselor.

Please answer the questions below with careful consideration and return as soon as possible to: Beaver Creek Youth Camp, Attn: Camp Manager, P.O. Box 186, South Fork, CO 81154. We greatly appreciate your input and your time.

1) What is your relationship to the applicant? ___________________________________________________________

2) How long have you known the applicant? ____________________________________________________________

3) How well do you know the applicant? _______________________________________________________________

4) How would you describe the applicant? ______________________________________________________________

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5) How would you describe the applicant's ability to relate to children and/or youth? __________________________

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6) How would you describe the applicant's ability to relate to adults and/or take instruction? ___________________

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7) How would you describe the applicant's work ethic? ___________________________________________________

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8) How would you feel about having the applicant as a volunteer worker with your child and/or youth? ____________

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9) Do you know of any characteristics that would negatively affect the applicant's ability to work with children and/or youth? If so, please describe. ___________________________________________________________________

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10) Do you have any knowledge that the applicant has ever been convicted of a crime? If so, please describe.

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11) Please list any other comments you would like to make in regards to the applicant: __________________________

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Reference Signature: _______________________________ ______________ Date: _____________________________