Name      Date Graduated from High School
Social Security #

Permanent Address
Home Phone 
School Presently Attending 
School/other Address
School/other Phone

Position for which you are applying
Name and address of your church 
Minister's name Telephone

EDUCATION:
High School (and location) attended
Dates attended
College/s attended dates
Major subjects
Degrees 

EMPLOYMENT, as well as volunteer experience working with youth ages 5-18:
List Dates, Employer/Supervisor, addresses, phone and nature of work--LIST AT LEAST TWO

CAMP EXPERIENCE:
List Dates, Camp Name, Director (if known), Address, and Position you filled:

Dates you are available From to

HEALTH:
Are you in good health?   Check one: Yes   No   Do you  have any physical or mental impairments
that would keep you from full participation in the position for which you are applying?
Yes   No  If Yes, please explain below:

CERTIFICATION:
Please check certification for which you will have a CURRENT card during the upcoming summer:
Lifeguard ;  WSI ; Canoeing ; Ropes Course ;  WFA ; WFR
In the space below, list any additional certification you currently hold which would be useful around camp:

In the space below, please answer the following questions:
1.  Why do you wish to spend the summer in a Christian Camp?
2.  Name one of your best friends and tell why that person is special to you.
3.  How do you enjoy sharing your faith with others?
4.  How would you seek to build a Christian community with a group of campers (12 children/youth)?
5.  What unique contributions can you make to the camp community?
6.  Describe some leadership/teaching positions you have held.

Please check the correct box if you have ever been convicted of any of the following offenses:
Child abuse ; Sex-related crime ;Operating a vehicle under the influence of alcohol or any other controlled substance ;  If yes to any of the above, please explain the the following box.

REFERENCES:
List three adults, other than relatives and classmates, who have worked closely with you and have observed you at work with children or peers.  One of your references must be your pastor.  Complete address and telephone numbers are necessary.

The information provided above is accurate to the best of my knowledge.  I understand that any intentional falsification of information may be grounds for immediate dismissal from employment.  I further authorize the Presbytery of the Peaks to contact given references and past employers, and I release from liability all representatives of the Presbytery of the Peaks and all individuals and/or organizations who provide information to the Presbytery of the Peaks in good faith, without malice, concerning my competence, ethics, character, and other qualifications relating to my employment.
   By checking  this box and submitting this application, I agree that I have read and understand the above statement.