THIS SECTION TO BE COMPLETED BY APPLICANT'S IMMEDIATE SUPERVISOR OR WORK REFERENCE

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NAME OF APPLICANT: ____________________________

YOUTH CORPS
(IF APPLICABLE): _________________________________

PLEASE COMMENT ON THE FOLLOWING AREAS:

1. Applicant's ability to work and live cooperatively with peers:

2. Work Performance (punctuality, work pace, work quality, learning ability, enthusiasm for work, ability to follow directions, safety consciousness):

3. Physical Fitness (include information on general health & physical condition, disabilities, any limitations):

4. Medical Record (work-related injuries, frequency of illness):

5. Applicant's ability to accept supervision, suggestions for improvement, and maintain safe practices and work pace with minimal supervision:

6. Please describe how the applicant responds to stressful situations (is the applicant unusually temperamental or easily frustrated?):

7. Applicant's achievements, contributions, and quality of participation as an employee, or a member of a community:

8. Please describe any serious policy infractions:

9. How high is the applicant's level of desire for a Backcountry position?

10. Please provide any other information which you believe the Selection Panel should consider regarding this applicant:

IMMEDIATE SUPERVISOR
(REFERENCE): __________________________________
DATE: ___________________________