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Parents: To ensure proper screening and fair representation, this
application MUST be completed solely by the applicant. Thank you.
Statement of Practice
In order to safeguard the well-being of the guests served, Camp Berachah will investigate the accuracy of the data provided in the application process for all applicants before appointment to the camp staff can be made. This investigation will include, but is not limited to, reference checks to past employers, the military, educational institutions, volunteer organizations, civic groups, and law-enforcement agencies.
Position(s) Applied For: Preference 1: Preference 2: Preference 3:
Preference 1:
Preference 2:
Preference 3:
If part-time or volunteer, Days and times available
Sun Mon Tue Wed Thu Fri Sat
Date Available:
START END
Paid full-time Paid part-time Volunteer Summer Salary Required
Personal
Name:
Telephone:
A.K.A:
Email:
Address:
How long at this address? From: To Present:
Previous Addresses (Past 10 Years):
1.
2.
Birthdate:
Age:
Gender::
Select One Male Female
Marital Status:
Select One Married Single Separated Divorced
Children:
Ages:
Housing Needs:
Select One On Camp Off Camp
Do you drive?
Select One Yes No
License held / #:
U.S.Citizen?
Visa Type, if not a citizen:
How referred to Camp Berachah?
Christian Experience
1. Do you have a personal relationship with Jesus Christ?
Choose one YES NO
Please describe.
2. How often do you attend church?
Describe your involvement.
3. What is your church affiliation & Christian background experience (i.e. charismatic, traditional)
4. Describe your ministry experience. (i.e. leading bible study, worship, etc).
5. Please briefly describe what you believe about:
Personal Beliefs:
Values:
The Bible
Tobacco/drugs/alcohol
Salvation & how to lead a camper to Christ
Body art/piercing
Jesus Christ
Pre-marital sex
The Holy Spirit
Homosexuality
Gifts of Spirit
Prayer
Start with your present or last job. Include any job-related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status.
Employer #1
Dates Employed
Work Performed
From
To
Address
Hourly Rate/Salary
Phone Number
Starting
Final
Job Title Supervisor
$
Reason for Leaving
Employer #2
Summarize special job-related skills and qualifications acquired from employment, ministry or other experience:
Have you ever had any job-related training in the United States military? Y/N? Yes No
If yes, please describe.
Special Skills & Qualifications
List professional, trade, business, or civic activities and offices held. You may exclude organizations which indicate race,
color, religion, gender, national origin, handicap or other protected status.
Specialized training, apprenticeship, skills and extra-curricular activities
State additional information you feel may be helpful
Elementary School
High School
College/University
Graduate/Professional School
School Name
Location
Year Completed
4 5 6 7 8
9 10 11 12
1 2 3 4
Diploma / Degree
Describe Course of Study
Additional
Are you physically or otherwise unable to perform the duties of the job for which you are applying?: Y/N? Yes No
If YES, please explain:
Have you ever been accused or convicted of any criminal offense? Y/N? Yes No If yes, explain:
Have you ever had DSHS or other childcare/adult contracts or licenses terminated of denied? Y/N? Yes No
If yes, explain:
Applicant's Statement: I certify that the answers given herein are true. I authorize a government background check and investigation of all statements contained in this application for employment. In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge.
Signature/Name Date
