An applicant you know is under consideration to be a counselor at Camp Honey Creek for Girls. Her duties will require her to be in contact both with young girls from the age of six through seventeen and with adults of all ages. In light of this information, an honest and thoughtful appraisal of her character and personality will be of the greatest help to us and will be treated in the strictest confidence. Will you please give us your candid opinion of the applicant? Applicant’s Name:I. Superior Good Average Poor NAPhysical health and stamina Emotional stability Promise and capacity for development of emotional stability Humor and flexibility Cooperative and alert attitude Exhibits loyalty and integrity in all associations Conservative good taste in dress and general behavior

Does applicant seem to you to display normal intelligence plus sound common sense? ___ Yes ___ NoIs applicant hyper-critical or hyper-sensitive? ___ Yes ___ NoDoes applicant possess any physical, mental or emotional limitations which might seriously detract from

possible job performance? ___ Yes ___ No

II. In your opinion, is the applicant mature enough to: Superior Good Average Poor NABe responsible for children in a camp setting? Work with children with genuine patience, enthusiasm and skill? Get along with co-workers under close living conditions? Place needs of others and the group above own desires and needs? Assume responsibility for carrying out delegated duties? Discipline self in order to use her time to best advantage? Accept on-going guidance and supervision? Accept constructive criticism as well as praise? Flexible enough to accept changing conditions and assignments? Abide by camp policies? Maintain energy and enthusiasm over an extended period? Make responsible decisions in emergency situations?

III. Please check the statements which best describe this applicant:___ almost always seems happy ___ talks to supervisor about problems in job___ gets along well with all people ___ follows through on responsibilities___ does not make a good first impression, but ___ gets angry easily – loses temper wears well ___ has self-confidence___ accepts suggestions and corrections graciously ___ finds change difficult___ feels that supervisors are unduly critical ___ takes initiative___ tends to be dictatorial ___ adaptable to situations ___ tolerant of other’s ideas and desires ___ self-centered ___ lacks self-confidence ___ discusses job problems with everyone___ often moody and depressed ___ has a genuine interest in people___ seems to enjoy dissention

CAMP HONEY CREEKP.O. Box 140 Confidential Appraisal FormHunt, TX 78024

IV. Are you related to applicant in any way? ___ Yes ___ No If yes, how

V. How long have you known applicant? Would you hire this applicant? ___ Yes ___ No

VI. Do you know of any religious, cultural or racial prejudice applicant might have that would limit the applicant’s ability to work with all children and staff? ___ Yes ___ No

VII. Do you know of any personal habits, behavior or any other circumstances (i.e.: drugs, alcohol, etc.) which, in your estimation, disqualifies applicant for the position of guiding and instructing young girls? ___ Yes ___ No If yes, please explain:

VIII. Would you be willing for your daughter to be associated with the applicant in a living and teaching situation such as this? ___ Yes ___ No

IX. Do we need to check additionally on this applicant? ___ Yes ___ No

X. Do you know if applicant has ever been convicted of a felony or misdemeanor? ___ Yes ___ NoIf yes, please explain:

PLEASE LIST ANY OTHER INFORMATION YOU FEEL WOULD IN ANY WAY BE HELPFUL IN GIVING US AN INSIGHT INTO THIS APPLICANT’S CHARACTER, JOB PERFORMANCE, AND ABILITY TO BE A POSITIVE ROLE MODEL FOR OUR YOUNG CAMPERS. THANK YOU.

Date _______________________________________ Name _______________________________________

Title _______________________________________

Phone Number _______________________________________

CAMP HONEY CREEK, BOX 140, HUNT, TX 78024PHONE 830-238-4630 FAX 830-238-4136 E-MAIL chc@camphoneycreek.com