PRESBYTERY OF THE PEAKS
CAMP AND CONFERENCE MINISTRIES
1022 Floyd Street Suite A
Lynchburg, Virginia 24501
Phone (888)-557-3257
Fax 434-847-4650
Summer Camp Employment Application
Return to:
Summer Camp Program Director
C/o Presbytery of the Peaks
1022 Floyd Street Suite A
Lynchburg, VA 24501
(Please type or print)
Name
_________________________________SS#________________________Position for which you are applying_____________________________________________________________________
Name of church and address
_______________________________________________________EDUATION:
School(s) Major subjects Dates Attended Degrees
____________________________________________________________
_____________________________________________________________
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EMPLOYMENT,
as well as volunteer experiences working with youth, ages 5-18: List previous work experience.________________________________________________________________________________
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CAMP EXPERIENCE:
Dates Camp Name Camp Director Address Position
________________________________________________________________________________
________________________________________________________________________________
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Dates available: From_____________________________________to___________________________________
Do you have any physical or mental impairments which would keep you from full participation in the position for which you are applying? Yes_____No_____if yes please explain.
Please check certification for which you will have a CURRENT card during the upcoming summer. Lifeguard:____ WSI:___
Canoeing:___ Ropes Course:___ WFR___ WFA___. List any additional certifications you currently hold which could be useful around camp
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________________________________________________________________________________________
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In the following list, put “1” before those activities which
you can organize and teach/lead as an expert:
“2” for those activities which you can assist in teaching/ leading:
and, “3” for those which are just your special interest or hobby.
Arts & Crafts Camping/Homesteading Dramatics Sports Nature
___Indian Lore ___Hiking ___Creative ___Ropes ___Birds
___Macrame ___Orienteering ___Directing ___Volleyball ___Conservation
___Nature Crafts ___Outdoor Cooking ___Skits ___New Games ___Flowers
___Painting ___Overnight Camping ___Other_________ ___Fishing ___Forestry
___Sketching ___Backpacking ___Softball ___Animals
___Woodworking ___Other____________ ___Frisbee ___Insects
___Lashing Music ___Caving ___Weather
___Weaving Waterfront ___Instruments ___Bicycling ___Trees & Shrubs
___Leather ___Canoeing ___Lead Singing ___Other_____
___Other_______ ___Guarding ___Other________ ___Other______
___Swimming ___Other______________
Please list any other talents or hobbies you possess which might be useful additions to our summer program.
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On separate paper, 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.
Have you 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, any
other felony? Yes____No_____ If yes to any of the above, please explain.______________________
References: List three adults, other than relatives and classmates, who have worked closely with you and who have observed you at work with children or pets.
One of your references must be your pastor. Complete address and telephone numbers are necessary.1.______________________________________________________Telephone_________________________
_________________________________________________________________________________________
2._________________________________________________________Telephone________________________
_________________________________________________________________________________________
3._________________________________________________________Telephone_______________________
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The information provided above and on attached sheets 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. I further state that I have not been convicted nor have pending charges of child abuse or other criminal charges.
Signature of applicant
_________________________________________________________
Date _____/_____/_____