YMCA Day Camp Reference Check

Dear Reference,

The applicant who has listed you as a reference is applying for a position with the YMCA of Niagara Day Camps.

Camp staff work closely with campers; they are expected to share in the leadership of camp, particularly by serving as positive role models. The applicant, if selected, will need to work in a group environment, communicate clearly with campers and peers, participate in activities, and follow safety guidelines to ensure success for participants.

Please complete this form to the best of your knowledge; it will help us make the best possible decision concerning the applicant. Your candid assessment of his/her suitability for working with children is essential. All references are strictly confidential; we do not share them with the applicant.

If we require any additional information or have questions about your responses, we will reach out to you at the phone number you provide below.

Thank you for taking the time to be a reference!

Applicant's name *

First

Last

Reference's name *

First

Last

Reference's title/position

Contact number

Contact e-mail *

How long have you known the applicant? Please describe your working relationship.

What were the applicant’s primary responsibilities in this role? Why did they leave this role (if former)?

What would you describe as the applicant’s key strengths?

What would you describe as an area for further development?

Please rate the applicant’s ability to:

	Very poor	Below average	Average	Good	Excellent
Demonstrate concern for health and safety	Demonstrate concern for health and safety Very poor	Demonstrate concern for health and safety Below average	Demonstrate concern for health and safety Average	Demonstrate concern for health and safety Good	Demonstrate concern for health and safety Excellent
Their ability to problem solve and deal with challenging situations	Their ability to problem solve and deal with challenging situations Very poor	Their ability to problem solve and deal with challenging situations Below average	Their ability to problem solve and deal with challenging situations Average	Their ability to problem solve and deal with challenging situations Good	Their ability to problem solve and deal with challenging situations Excellent
Guide, motivate and inspire others	Guide, motivate and inspire others Very poor	Guide, motivate and inspire others Below average	Guide, motivate and inspire others Average	Guide, motivate and inspire others Good	Guide, motivate and inspire others Excellent
Give direction to groups with various skills and talents	Give direction to groups with various skills and talents Very poor	Give direction to groups with various skills and talents Below average	Give direction to groups with various skills and talents Average	Give direction to groups with various skills and talents Good	Give direction to groups with various skills and talents Excellent
Take appropriate risks when required	Take appropriate risks when required Very poor	Take appropriate risks when required Below average	Take appropriate risks when required Average	Take appropriate risks when required Good	Take appropriate risks when required Excellent
Involve others in discussion, planning and implementing	Involve others in discussion, planning and implementing Very poor	Involve others in discussion, planning and implementing Below average	Involve others in discussion, planning and implementing Average	Involve others in discussion, planning and implementing Good	Involve others in discussion, planning and implementing Excellent
Act as a personal role model	Act as a personal role model Very poor	Act as a personal role model Below average	Act as a personal role model Average	Act as a personal role model Good	Act as a personal role model Excellent
Share a leadership role with others	Share a leadership role with others Very poor	Share a leadership role with others Below average	Share a leadership role with others Average	Share a leadership role with others Good	Share a leadership role with others Excellent
Be dependable and reliable	Be dependable and reliable Very poor	Be dependable and reliable Below average	Be dependable and reliable Average	Be dependable and reliable Good	Be dependable and reliable Excellent
Relate to others (peers and customers) on the job	Relate to others (peers and customers) on the job Very poor	Relate to others (peers and customers) on the job Below average	Relate to others (peers and customers) on the job Average	Relate to others (peers and customers) on the job Good	Relate to others (peers and customers) on the job Excellent

The YMCA has a Child Protection Policy in place. A responsibility of this position may require the applicant to have contact with children and/or vulnerable persons. Are you aware of any issues or incidents, or do you have any concerns related to the applicant being in contact with children and/or vulnerable persons?

Is there anything related to work performance or this individual you would additionally like to discuss and would you rehire them?

Acknowledgement *

The information I have provided in this online reference is accurate and reflective of the applicants skills to the best of my knowledge. I understand that the YMCA may contact me to verify the information provided.