Confidential Staff Reference

Thank you for agreeing to complete this form for our files! If you have any questions or concerns about this document, please contact us at

Applicant's Name *
Applicant's Name
Today's Date *
Today's Date
Motivation *
For this and the following questions, please select the description which best applies to the applicant.
Leadership *
Dependability *
Work Habits *
Peer Compatibility *
Responsibility *
Emotional Maturity *
Concern for Children *
For this and the following questions, please give your opinion on the applicant's characteristics
Enthusiasm *
Loyalty *
Professionalism *
Willingness to Take Direction *
Attitude Towards Criticism *
Sense of Humour *
Outgoing *
Friendly *
Adaptability *
Camping Skills *
Ability in second language (French or English) *
If you had a child attending summer camp, would you be happy to have this applicant as your daughter's counsellor for two to four weeks? *
Your typed name will act as a handwritten signature
Phone *

If you have any more detailed comments or information you would like to share concerning the applicant, please contact us by phone at 819-424-2662 or send us an email at