Reference Questionnaire

Please print 3 copies of this document and ask each of your three references to fill out and return the form to Christikon at the address listed below. A pdf version of this for printing on two pages is available by clicking here (PDF). It’s courteous to provide those completing references for you with a pre-addressed, stamped envelope. If preferred, this form may be copied and imported into your word processing program, completed, and sent by the person completing it as an e-mail attachment to A hard copy should still be printed out, signed, and mailed.
Confidential Reference Questionnaire:                                                    Christikon Lutheran Bible Camp, Inc

To be completed by the Applicant:

Applicant’s Name________________________________________
Position(s) for which you are applying________________________________________________
This reference form is available on-line at and may be imported into a word prcessor for completion.

To the person completing this Reference Questionnaire: The person named above is applying to serve on our summer staff. Your evaluation  of her/his potential is very helpful in the selection process. Thank you for your sincere and candid appraisal of her/his character and ability.

1. How long, how well, and in what capacity have you known the applicant?


In each of the following items, please check the phrase that most accurately describes the applicant’s usual behavior with regard to that specific quality or trait. Additional welcomed.

2. Leadership: How does this person direct and influence others in a work group?
Poor leader; incapable of directing or working with others
Usually follows the lead of others
Normally successful in directing and leading others
Very successful in leading others
Exceptional leader; inspires others along desired lines of action

3. Cooperation: How well does this person work with others in a group?
Cooperates grudgingly; makes trouble; obstructs group efforts
Cooperates somewhat, but tends to choose own interests over common good
Cooperates actively; helps things run smoothly
Exceptionally successful in working with others and inspiring confidence

4. Responsibility/trustworthiness: How responsible is this person?
Irresponsible even under supervision
Usually needs detailed instructions with regular checks of work
With close supervision will do satisfactory work
Carries out routine activity on own responsibility
Exceptionally able to accomplish work without close supervision

5. Willingness to improve: How does this person react to suggestions/criticism by others?
Takes criticism as a personal insult, resents suggestions
Listens to suggestions but often acts without considering them
Follows suggestions willingly when appropriate
Asks for criticisms and suggestions

6. Depth of conviction: How does this person put principles/convictions into action?
Displays a seriously under-developed system of values
Holds convictions, but fails to carry them out under adverse conditions
Acts according to convictions under normal circumstances
Carries our convictions constantly and boldly, even in the face of obstacles

7. Persistence: How well does this person follow though on tasks?
Needs much prodding to complete work
A bit indifferent unless deeply interested; may not finish task
Completes assigned tasks of own accord
Industrious, energetic, dependable at all times
Unusual perseverance; does more than expected

8. Stability: How well does this person control emotions?
Tends to over-respond (to stress, good fortune, etc.); over-emotional
Tends to be unresponsive; apathetic
Has difficulty expressing emotions; over-controlled
Usually well-balanced
Excellent balance of both responsiveness and self-control

9. Maturity of judgment: How does this person make decisions?
Immature; untrustworthy in situations of stress
About average for his/her age in judgments made
Above average; can always be counted on upon to use good common sense
Exceptionally mature; decides wisely and prudently, even under stress

10. If you have any reason to believe that it would be appropriate for this person to work closely with children, we invite further explanation on a separate sheet of paper. Any such comments will not be kept as a part of the reference, and will be destroyed after they are reviewed.

11. Suitability as a camp staff person: Rate this person by circling a number from one to ten:
Poor Prospect       1      2      3      4      5      6      7      8      9      10      Truly exceptional

12. Further comments on any of the following items, or others of your own choosing, are appreciated:

  • Other significant strengths or weaknesses
  • Christian character and commitment
  • ability to articulate his/her faith
  • theological perspective and/or style




Signature________________________________________Print/type name______________________________
Mailing Address__________________________________  Date______________________________________

Staff applications cannot be considered complete until references are received. Please return this by February 28th or as soon thereafter as possible to: CHRISTIKON ● 1108 24th St. W ●  Billings, MT 59102