Summer Staff Application

APPLICATION FOR CAMP MINISTRY

Last name:
First name:
Middle initial:
Name to be Called:
School street address:
City:
State:
Zip Code:
Box Number:

Home Street Address (For Mailings not to your School):
City:
State:
Zip Code:

Telephone: Home:
School:
Extension:
Cell:
Best time to call?
Social Security Number:
Email Address:
Facebook:
MySpace:
Drivers License Number:
State of License:
Gender:
Birth Date:
Age:

Have you ever filled out an appilication with us before?
If yes, Give the date:
Have you ever been employed with us before?
If yes, Give the date:
Have you ever been a camper at CoBeAc before?
If yes, Give the date:

What category(s) are you applying for?
First Choice:
Second Choice:
Third Choice:
How did you hear about Camp CoBeAc?

School Currently Attending:
Year Currently Attending:
Have you ever been expelled, dismissed, or suspended from school?
If yes, please exlain:

Please List your two most recent work experiences.
1
Employer:
Address:
Supervisor:
Telephone:
Dates Employed:
From:
To:
Position:
Responsibilities:
Reason for Leaving:

2
Employer:
Address:
Supervisor:
Telephone:
Dates Employed:
From:
To:
Position:
Responsibilities:
Reason for Leaving:

1
Name:
Address:
Relationship:
Telephone Number:

2
Name:
Address:
Relationship:
Telephone Number:

Church Membership:
Church Address:
City:
State:
Zip Code:
Phone Number:
Pastor's Name:
Youth Pastors Name:
Date of Salvation:
A breif summary of your salvation testimony:

Background checks are mandatory by Michigan state law. Criminal charges or convictions may not be cause for automatic disqualification for employment. The camp will consider the nature of the offense, the date of the offense, and the relationship between the offense and the position applied for.

Is there a criminal charge, felony, misdemeanor, or forfeiture currently pending against you?
(If "yes," write a breif exlanation describing the charge(s), legal jurisdiction and date.)

Have you ever been convicted of a crime, felony, misdemeanor, or other criminal offense.
If "yes," write a breif exlanation describing the charge(s), legal jurisdiction and date.

Have you ever been convicted of an offense involving a minor, or endangering the welfare of a child such as child abuse, child neglect, ect., or any offense against a person, such as physical or sexual assault?
If "yes," write a breif exlanation describing the charge(s), legal jurisdiction and date.

Is there anything that legally prevents you from working in the United States?
If "yes," provide an explination.

Do you currently have any infectious diseases?
If yes, what?
Do you have any physical limitations that would prohibit you from being involved in all camp activities?
If yes, what?
Do you require a special diet?
If yes, what?
List any allergies and/or any allergic reactions.

Do you Possess.
Lifeguard Certification:
First-Aid Certification:
Food Handler Certification:
Do you sing?
Solos:
Ensembles:
Vocal Range
Soprano:
Alto:
Tenor:
Bass:
Do you play any musical instruments, and if so, which instruments?

Do you have experience in:
Video:
Sound Equipment:
Landscaping:
Electrical:
Photography:
First Aid:
Carpentry:
Coaching Experience:
Office Skills:

I hereby certify that the above information to the best of my knowledge is true, accurate, and complete. Any misrepresentations or willful omissions of facts shall be sufficient cause for disqualification of this application or termination of my service. Furthermore, I understand that this application and records become the property of Camp CoBeAc, which reserves the right to accept or reject me from service. I further agree to abide by all rules, regulations, and policies of the camp. I agree to any medical examination or drug testing which may be required upon offer of service and understand that my service is contingent upon successful completion of the examination. I understand that service at camp is “at will” and may be terminated by Camp CoBeAc or myself at anytime for no reason.

I further authorize Camp CoBeAc to contact references, past or present employers, and any other source of information which may be relevant to my application. I authorize these references, employers, and sources to furnish any and all information requested. In addition, I hold harmless and release the above stated entities from all liability and/or damage associated with provision of this information. This authorization voids any prior written or verbal agreements limiting release of said information.

I understand Camp CoBeAc is a conservative Christian camp serving Baptist churches throughout the Great Lakes Region. I am convinced my reputation, current lifestyle, personal standards and theological beliefs would be consistent with those of Camp CoBeAc and its constituency.

Electronic Signature:

Date: