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Nebraska Lutheran Outdoor Ministries

Carol Joy Holling Camp • Day Camp • Sullivan Hills Camp 
27416 Ranch Road
Ashland, NE  68003-3518

Toll free: 1-888-656-6254

Reference Form

In asking you to serve as a reference the applicant is authorizing the release of information regarding their employment and performance. They are further releasing employers, person and Nebraska Lutheran Outdoor Ministries from any and all liability of whatever nature on account of furnishing such information.

Applicant Name

Position Desired

The individual listed above would like to join us this coming summer as a part of the NLOM Summer Ministry Team/Camp Staff. Because we assume an enormous responsibility for other people’s children. We want to be sure the people we hire as NLOM staff are indeed the quality role models they appear to be. We would appreciate honest opinions. Often a small negative that you would prefer to overlook proves, under further scrutiny, to be just that - a small, correctable quirk. On the other hand, it could conceivably connect to some other incident, something serious, that neither of us would have suspected. If you do not know the applicant in a camp setting, answer the questions from your own frame of reference.

Responsible 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Trustworthy 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Organized 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Outgoing 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Accepting of Differences 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Teachable 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Able to follow directions 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Able to delegate/direct others 1 - Not Typical 2 3 - Sometimes 4 5 - Always

High level of stamina 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Eager to learn 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Self starter 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Adaptable and flexible 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Driven by Christian faith 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Smiles and is friendly 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Positive first impression 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Comfortable with self 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Fun 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Able to complete projects 1 - Not Typical 2 3 - Sometimes 4 5 - Always

A team builder 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Maturity 1 - Not Typical 2 3 - Sometimes 4 5 - Always

Which age group does the applicant work best with?

K-2nd3rd-5th6th-8th9th-12th

How long have you known the applicant?

In what capacity?

Co-workerSupervisor/EmployerTeacherFamily FriendChurchOther

If the applicant was an employee, is he/she eligible for rehire?

YesNo

What do you see as the applicant's strengths?

How would you assess the applicant's Christian faith?

Would you want this person to be your child's camp counselor? Why or why not?

Describe the applicant's leadership style.

Would you describe the applicant as having a driver, amiable, analytical or entertainer personality? Explain.

Do you have any concerns about the applicant's ability to serve?

Are you aware of (select if yes)

Illegal drug useAlcohol abuse or suspected alcoholismChild abuse or sexual abuse offenses

Other comments that might be helpful?

Your name

school or business

Address

City, State, Zip

Daytime phone number

E-mail address

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