Today's Date:
Name:(First and Last)
What do you prefer to be called?
Date of birth?
T-Shirt Size:
Present Address:
Parents Address: (If different from above)
Home Phone:
Cell Phone:
Alternative Phone:
Email Address:
Website, Blog, MySpace, Facebook:
Best time to contact you at home?
High School:
School Activities:
Diploma Received? Yes
City and State:
School Activities:
Other Graduate of Professional Degrees:
Are you currently employed?
May we contact your current employer? Yes
Employers Phone:
Are you prevented from lawfully becoming employed in this country? Yes
If Yes, explain:
Date available to work?
Explain any conflicts in your availability to work:
List three recent employers: (Supply supervisor names, contact information, positions responsibilities and the reason for leaving.)
Comments: (Please explain any gaps in employment history.)
Do you play a musical instrument? Yes
If so, what instrument?
If you play guitar can you lead music? Explain the level of your ability and any experience you may have.
List any specialized training, apprenticeships, skills or extra-curricular activities:
Describe any job-related training or training in the United States Military.
List professional, trade, business or civic activities or offices held.
Additional information and other qualifications: (Summarize special job-related skills and qualifications.)
Special Talents or Skills: (Check if you have any level of experience and check all that apply.) Bible Study
Worship Leading
PC/MAC Skills
Ground keeping and landscaping
First Aid Certification
Nature or Environmental Education
Campfire Building
Song Leading
Juggling or Circus Skills
Arts and Crafts
CPR Certification
Outdoor Survival Skills
Hiking and Camping
Horseback Riding
Drama or Acting
Custodial / Maintenance
High or Low Ropes Course Experience
Lifeguard Certification
Food Service or Cooking Experience
Rafting / Kayaking
Nature Studies
Clowning or Mime
Please explain further any skills or talents you have that would be useful with children at camp:
Have you ever been convicted of a felony or misdemeanor? Yes
If yes, please explain:
Do you have a current/valid driver's license? Yes
Driver's License Number:
State Issued:
Do you attend a church? Yes
Where do you worship?
How involved are you in your Church? Very involved
Pretty involved
Not involved
Explain your involvement and the areas where you serve.
Please explain experience in caring for or supervising children and youth?
How would you help a camper's experience being an active participant in a Christian community with other campers?
Explain how you see yourself in the role of a camp counselor. What kind of counselor will you be?
Please write a statement of faith describing your Christian experience and how it relates to your life and those around you.
Reference #1:
Relationship or Occupation:
Reference #2
Relationship or Occupation:
Reference #3:
Relationship or Occupation:
May we contact your references? (References must be checked for employment.) Yes
NOTE TO ALL APPLICANTS: Do Not answer this question unless you have been informed about the requirements of the job for which you are applying. Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? Yes
Rockhaven Camp is an equal opportunity employer. We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital status, or any other legally protected status. I understand
APPLICANT'S STATEMENT: I certify that my answers given herein are true and complete. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. This application for employment shall be considered active for a period of time not to exceed 45 days. Any applicant wishing to be considered for employment beyond this time period should inquire as to whether or not applications are being accepted at that time. I have read and agree to:
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. I have read and agree to:
In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge. I understand, also that I am required to abide by all rules and regulations of the employer. I have read and agree to:
Checking YES will serve as my signature which will indicate that I agree to all of the terms of this application. Yes

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