2010 Confidential Reference Form
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Relationship to Applicant: --Select OnePastorRelativeOther Adult
Staff Position --Select OneKitchenMaintenanceLifeguardNurseYouth CounselorHaven CounselorSummer Secretary Applicant
How long have you known the applicant?
The above named person has applied for a position at Delta Lake Bible Conference Center. Delta Lake is a Christian Camp whose primary goal is ministering to the Spiritual needs of each individual camper. The role of every staff member is vital in that ministry. In that light, please evaluate the candidate appropriately. Thank you for your response.
Directions: Select One for Each Trait (Favorable, Average, or Unfavorable)
Leadership Skills ----FavorableAverageUnfavorable Spiritual Motivation ----FavorableAverageUnfavorable Discretion with Opposite Sex ----FavorableAverageUnfavorable
Emotional Stability ----FavorableAverageUnfavorable Maturity ----FavorableAverageUnfavorable Integrity/ Honesty ----FavorableAverageUnfavorable
Modesty ----FavorableAverageUnfavorable Concern for Others ----FavorableAverageUnfavorable Social Skills ----FavorableAverageUnfavorable
Respect for Authority ---FavorableAverageUnfavorable Judgment/Discernment ----FavorableAverageUnfavorable Self Image ----FavorableAverageUnfavorable
Regular Attendance (Check those he/she attends):
SS AM PM Youth Prayer Meeting Other:
Directions: Please answer the following questions completely, to the best of your ability.
1. To your knowledge has the applicant made a personal commitment to Jesus Christ, and on what evidence do you base your conclusion?
2. Are there any habits or issues about the applicant which may hinder his or her involvement at Delta Lake Bible Conference Center?
3. What factors in the applicant’s home life would hinder or encourage his or her involvement at Delta Lake?
4. Describe how the applicant has grown/matured in the past two years spiritually, emotionally, and socially.
5. What are the applicant’s talents and strengths (art, drama, music, athletics, etc.) and how has he/she applied them to church, community, and school?
6. Has the applicant demonstrated leadership skills, works in a leadership position, or is being considered for a leadership position within the church he/she attends. If yes, please explain. If not, why not?
7. Are you recommending this Applicant more for what he/she can contribute to our program or more for what we can do for him/her? Please explain:
On the bases of my knowledge of this applicant, he/she is (check one):
Recommended with confidence Recommended with some reservations Not recommended
Typed Signature Date Relationship
Phone E-mail address: