Ingles

Vineyard International Counselor Program (V.I.C.P)Staff Reference Form, 2013 Season | RETURN TO:The Vineyard1945 Vineyard Rd.Westfield, NC 27053USATel: 1-336-351-2070Fax:1-336-351-2902vicp@vineyardcamp.comwww.vineyardcamp.com |
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Please check sessions(s) of attendance: A B C D E F G H I J K L M |

Name of Applicant: | Alfredo Hernandez Aguirre | Name of Reference: |Esmeralda lopez cruz |
Relation of Reference to Applicant: | chief |
(The one giving reference must be the Priest / Minister, Professor, or Employer of the applicant) |

The above-mentionedapplicant has applied to serve as a Summer Counselor at a camp for children 6-16 years old in the USA. As a sponsoring agency of the United States State Department, we must receive at least threereferences on this applicant. Please assist us by answering the following questions as honesty as possible.

Thank you for your time and concern.Sincerely Yours,Dean BarleyExecutive Director and President| CERTIFIED BY: www.ccca-us.org www.summercamp.org |

How long have you known the applicant? | 2 years |

In what capacity have you known this person?| employed |

To the best of your knowledge,

A. Has this person ever been convicted of a crime? | NO | | YES | |

B. Is a trial pending for this person? | NO | | YES | |

C. Has thisperson ever been fired or terminated by an a employer? | NO | | YES | |

D. Has this person ever been involved with sale, production or distribution of pornographic materials? | NO | |YES | |

E. Has this person been accused of sexual assault? | NO | | YES | |

F. Has this person been involved in prostitution? | NO | | YES | |

G. Has this person been accused ofindecent exposure? | NO | | YES | |

H. Has this person been accused of sexual contact with children? | NO | | YES | |

I. Does this person have a history of alcohol abuse? | NO | | YES | |...