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
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
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)
Initiative / Self-Motivated
Ability to Relate to Children
Responsible / Conscientious
Conscious of Self-Presentation
How would you rate this person’s overall potential
to perform the job being applied for?
Reference form Continues . . .
H.U. Box 10844
Searcy, AR 72149