Tahkodah Counselor Application • Revised November 14, 2016 • page 7
Reference Form Tahkodah Applicant’s Name: _______________________________
(Applicant should copy this & give to three individuals or have them download from
http://www.harding.edu/tahkodah)
REFERENCE INFO
Name ___________________________________________
Position _________________________________________
Phone(s) ________________________________________
Email ___________________________________________
The applicant listed above has applied for a position on the Camp Tahkodah counseling staff. Tahkodah counselors serve as the
primary supervisors of 8-18 year old children on a 24/7 basis and are responsible for their overall well-being. Your name has been
given to us as a reference for this applicant. We would appreciate your completing this form and returning it to us as soon as
possible. Your reply will be held confidential; applicants will not have access to your responses. Thank you very much for your
assistance with this inquiry. If you wish to discuss this applicant further, I invite you to contact me. My contact information is
listed below.
1. In what capacity do you know the applicant? __________________________ How long? ________
2. If employer, what was the reason for termination?
3. How would you feel to learn that your own child was going to be supervised by this person?
4. How would you rate this applicant’s performance? (check one column for each row below)
EXCELLENT
GOOD
ACCEPT-
ABLE
BELOW
AVERAGE
WEAK
UNKNOWN
Spiritual Maturity
Integrity / Character
Emotional Stability
Common Sense
Initiative / Self-Motivated
Ability to Relate to Children
Displays Good Judgment
Responsible / Conscientious
Attendance / Punctuality
Open to Supervision
Leadership
Flexibility
Conscious of Self-Presentation
Enjoyable to Be With
How would you rate this person’s overall potential
to perform the job being applied for?
Reference form Continues . . .
R
ETURN
C
OMPLETED
F
ORM
T
O
:
Camp Tahkodah
H.U. Box 10844
Searcy, AR 72149
~or~
tmcneal@harding.edu
Tahkodah Counselor Application • Revised November 14, 2016 • page 8
The things that have most impressed me about this person are:
If I had to choose, the things that most concern me about this person serving in this role are:
Please write additional comments you feel might help us discern the suitability of this applicant.
Have you had an opportunity to witness this person interact with children or teens? Yes / No
If so, please describe the nature and quality of such interactions:
I recommend this person for a position as a counselor at Tahkodah with no reservations.
I recommend this person for a position as a counselor at Tahkodah with some reservations.
I do not recommend this person for a position as a counselor at Tahkodah.
________________________________________ ____________________
Signature of Reference Today’s Date
I thank you for serving as a reference. Please contact me if you think it best to discuss this applicant’s qualifications.
Travis McNeal, Camp Tahkodah Director
tmcneal@harding.edu
501-279-4564 (w) or 501-827-0080 (m)
click to sign
signature
click to edit
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