Heights Church - HeightsAir
2015 Going Vertical Staff Application
The following information is kept confidential and
will be prayerfully examined as you are considered
for a Going Vertical Camp position with Heights Church.
Please complete in ink.
Tell us a little about you:
Today’s Date:
Name:
(first)
(full middle)
(last)
Other Names Used (Nicknames, AKA’s):
School you attend:
Year in School:
Work Eligibility:
Are you legally eligible to work in the U.S.? Yes No
If yes, are you able to show proof of work eligibility to be employed? Yes No
Are you age 18 or older? Yes No
If no, what is your age?______
Have you ever been convicted of a felony? Yes No
Contact Information:
Home Address:
City:
State:
Zip Code:
E-mail:
Primary Phone:
Cell Home Work
Secondary Phone:
Cell Home Work
Preferred Communication Method: Primary Phone Secondary Phone Email Text Msg.
Parents/Guardians Names:
Parents’ phone number:
Do regularly attend Heights Church? Yes No
If not, where do you attend?_______________________________________________________
How long have you been attending?
What services do you attend?
Availability:
Camp Blocks: (please mark blocks that you are available every day from 8:00a to 3:30p)
Week 1 > June 8 thru 11
Week 4 > July 6 thru 9
Week 2 > June 15 thru 18
Week 5 > July 13 thru 16
Week 3 > June 22 thru June 25
Week 6 > July 20 thru 23
Off Week > June 29 thru July 3
What areas have you served in at Heights:
Ministry?
What Capacity?
When?
Reference:
Please provide us with information on two people who know you well and can provide a
personal reference.
Name
Name
Your
Relationship
Your
Relationship
Address
Address
City, State, Zip
City, State, Zip
Phone
Phone
Who is Jesus to you?:
What is your definition of a servant?:
Age of kids I most enjoy working with:
I enjoy working with kids because:
I want to work Going Vertical Camp because:
Skills / Sports / Hobbies / Experience that I could share with kids / teach kids:
Employment History: please list former employers, if any.
Position Title:
Employer:
Contact Phone #:
Address:
City:
Employment Dates: (start)
(end)
Direct Supervisor:
Rate of Pay: $
State:
Zip:
May we contact employer: Yes No
Reason for Leaving:
per
Hours Per Week:
Primary Job Responsibilities:
Safety and Security:
The following questions reflect our commitment to provide protective care of all children as well as volunteers who participate
in Heights Children’s Ministry. If you prefer, you may discuss your answers in confidence with the church leadership rather than
answering them on the form. Answering yes, or leaving the question unanswered, will not automatically disqualify you.
Have you ever been investigated for, accused, suspected, indicted, or convicted of any crime involving child abuse, child sexual abuse,
attempted sexual abuse of a minor, or any other crime involving children? Yes No
If yes, please explain:
Have you ever abused or molested a minor in any way, regardless of whether there was any criminal investigation or conviction?
Yes No If yes, please explain
Have you been a victim of physical or sexual abuse as a minor? Yes
No
By signing I agree to support and follow Heights Church Child Protection Policies.
Applicant’s Signature
Date
Please Read and Sign below.
I certify that the information given by me in this Employment Application is true and complete, I understand and agree that my
employment with this company may be immediately discontinued if misrepresentations, falsified statements, or material omissions are
found to have been made. I authorize schools, former employers, former supervisors and or any one named in this application form to
provide any and all information pertinent to my employability and hereby release those providing such information from any liability for
doing so. I also understand that employment, if offered, is contingent upon my providing additional information for employee record
purposes. I also agree to release and hold harmless Prescott Heights Church, its officers, employees, agents and volunteers. I further
understand that the term of employment at this company is for such a period as the company may deem my services to be satisfactory
and desirable. I will comply with and be governed by all company policies, rules, and procedures as may be in effect from time to time.
I understand that should I accept an offer of employment from Prescott Heights Church, I will for the entire term of my employment,
regardless of duration, be an “at-will” employee. This means that I will be free to terminate my employment from Prescott Heights
Church at any time, for any reason whatsoever, with or without good cause, and that Prescott Heights Church will be free to discharge
me at any time, for any reason whatsoever, with or without good cause. I understand that I will be an “at-will” employee regardless of
anything I may be told to the contrary by Prescott Heights Church personnel and regardless of anything that may be published
otherwise by Prescott Heights Church I have read the above, understand its content and meaning and voluntarily and freely agree to
all of its provisions. I understand that, upon my request, I will be provided a copy of my executed employment application.
Applicant Signature:
Date:
Complete a background check form and submit your application.