Summer Camp Winaukee 432 Winaukee Road Moultonboro, NH 03254 (603) 253-9272 Winter Camp Winaukee 3 New King Street White Plains, NY 10604 (800) 487-9157		Staff Reference Form Applicant's Name: (Required) The above named person has applied for a position at Camp Winaukee for Boys. We request that you complete the following reference form and be honest and as open as you can be in your review of the applicant. Your confidential evaluation of the applicant will help us assess the suitability of the applicant for a position within our community. It is most important for leaders children to be of high ideals, possess integrity, get along well with others in the intimate life of camp and demonstrate a willingness to do more than "his or her share." Life at camp is often highly charged and staff can lack privacy as we all live in an open and close knit community, please consider this when you provide your responses. Thank you for your response and kind assistance. Should you wish to elaborate on any of your responses, please do contact us at 800-487-9157 or via email at info@winaukee.com. Position Applying For: Motivation (Desire to learn) - Select One - Very ambitious Eager Average Indifferent Enthusiasm - Select One - Excellent Good Average Fair Poor Loyalty - Select One - Excellent Good Average Fair Poor Emotional Maturity (self-control) - Select One - Very mature Stable Well balanced Average Unstable Social Acceptability (response from others) - Select One - Sought out Well liked Accepted Avoided Tolerance - Select One - Excellent Good Average Fair Poor Energy - Select One - Excellent Good Average Fair Poor Responsibility - Select One - Seeks responsibility Assumes responsibility Accepts Avoids Communication - Select One - Excellent Good Average Fair Poor Social Attitude (concern for others) - Select One - Deeply concerned Interested Average Indifferent Humor - Select One - Excellent Good Average Fair Poor Understanding Children - Select One - Excellent Good Average Fair Poor Leadership - Select One - Always leads Often leads Seldom Follower Ability to Accept Supervision & Guidance - Select One - Excellent Good Average Fair Poor Appearance - Select One - Excellent Good Average Fair Poor Summary - Select One - Excellent Good Average Fair Poor   To the best of your knowledge has the applicant ever been investigated for allegations of child abuse? Yes No To the best of your knowledge has the applicant ever been convicted of a felony? Yes No Is there any reason you are aware of that this person should not work with children? Yes No If yes, please explain: Would you have any hesitation in allowing this applicant to be in a living situation (24 hr/day) with your or anyone's children? Yes No If yes, please explain: Please express any other comments regarding the applicant that you feel appropriate: How do you know the applicant: Your Name: (Required) Position: (Required) Company: (Required) Email Address: (Required) Phone: (Required) Please type the code shown in the image and then submit:
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