2015 Summer Intern Application
2015 Summer Internship Application Please complete this application and send it to us by May 15, 2015 along with a current picture of yourself. Return to Camp KidJam, Attn: Ricky Wise, 5870 Charlotte Lane, Suite 300, Cumming, GA 30040 Personal Data First Name __________________ Middle Name ________________ Last Name ________________ Birthday________________ Age ____________ Social Security # ___________________________ Home Address_____________________________________________________________________ Home Phone (______)___________________ Mobile Phone (_______)_______________________ Previous Address if moved in the last 12 months _________________________________________ Parents’ Names ___________________________________________________________________ Email _____________________________________________ School ____________________________________________ Grade _________________________ College____________________________________________ Major _________________________ School Address (if living there)________________________________________________________ School Phone (if living there) (______)________________ Years of College Completed __________ Career Plans ______________________________________________________________________ What campus ministries are you involved in?_____________________________________________ Where do you attend church?_________________________________________________________ Are you a member of this church? ______Yes _______ No If no, where?______________________________________________________________________ Youth Pastor ______________________________________________________________________ What church activities are you involved in?______________________________________________ T-Shirt Size ______________________ Camp Locations & Dates Dates Available (Please check camps of interest) ____ June 10-13, Southeastern University – Lakeland, FL ____ June 16-19, Lander University – Greenwood, SC ____ July 1-4, Fort Bluff Camp – Dayton, TN ____ July 6-9, Indiana Wesleyan University – Marion, IN ____ July 11-14, University of North Carolina-Wilmington – Wilmington, NC ____ July 15-18, University of North Carolina-Wilmington – Wilmington, NC ____ July 22-25, Texas Woman’s University – Denton, TX ____ July 27-30, Midwestern State University – Wichita Falls, TX Health Information Have you been to a doctor in the past two years? _____ Yes _____ No If so, for what reason: ______________________________________________________________ Are you presently taking any form of medication? _____ Yes _____No If so, for what reason: ______________________________________________________________ Have you ever been convicted of, indicted for, or pled guilty to a crime? _____ Yes _____ No If so, for what reason: ______________________________________________________________ _________________________________________________________________________________ Camp Track Choices Rate your top three choices that you would want to work: _____ Minute to Win It _____ KidJam Motor Speedway _____ Lego my Lego _____ Games on the Grass _____ Taking the Stage (drama) _____ CKJ TV _____ Game On! (sports) _____ Bust a Groove (dance) _____ For Girls Only _____ Mythbusters _____ Mythbusters (Super Charged) _____ Craftastic Art _____ For Dudes Exclusively _____ Team Competition _____ Project Runway Work History yy Feel free to use a resume instead. You may do this on a separate sheet if necessary. Employer ____________________________________ Supervisor ___________________________ Phone (______)______________________ Dates of Employment____________________________ Reason for Departure _______________________________________________________________ Responsibilities:____________________________________________________________________ _________________________________________________________________________________ Employer ____________________________________ Supervisor ___________________________ Phone (______)______________________ Dates of Employment____________________________ Reason for Departure _______________________________________________________________ Responsibilities:____________________________________________________________________ _________________________________________________________________________________ Employer ____________________________________ Supervisor ___________________________ Phone (______)______________________ Dates of Employment____________________________ Reason for Departure _______________________________________________________________ Responsibilities:____________________________________________________________________ _________________________________________________________________________________ References (Please Print) Reference 1 Name: Occupation: Location: Phone: Relationship: Reference 2 Reference 3 Application Questions Answer the following questions on a separate page. Please return with a photograph of yourself so that we can match your face with your name. 1. Write/Type a 1-2 page autobiography. Explain your testimony, your family situation, what your goals and aspirations are, where you have been and where you are going, how God has moved in your life, and anything else about your life that you feel is pertinent. 2. Why are you interested in working with Camp KidJam this summer? 3. Why should Camp KidJam hire you? Describe what you feel you have to offer the campers, other interns and the Camp KidJam Staff. 4. Describe your gifts, abilities, talents (i.e. technical skills, singing, dancing, acting, construction, etc.) 5. If chosen, what do you hope to gain from your experience as an intern at Camp KidJam? Release and Signature Code of Conduct Camp KidJam does not allow any of its employees/interns to be involved with smoking, drinking alcoholic beverages, or using illegal drugs while at camp. Also, theft, damaging property, physical injury to others, deception and other forms of socially unacceptable behavior will be causes for dismissal. I understand that this application form is intended for use in evaluating my qualifications for an internship. This is not an internship contract. I have answered all questions completely and accurately. I understand that any false statements, misrepresentations or omissions made during the interview and on this form are grounds for terminating the application process or, if discovered after accepted, terminating my internship. I understand that if I am offered a position, it will be offered on condition that my internship shall be at will and for no definite period pursuant to Camp KidJam’s Code of Conduct. I understand and agree that upon breaking the Code of Conduct, that my internship may be terminated by Camp KidJam at any time, with or without cause, and with or without notice, at the option of Camp KidJam. I authorize Camp KidJam and/or its agents to verify any of this information. I authorize all former employers, persons, schools, companies and law enforcement authorities to release any information concerning my background and hereby release any said persons, schools, companies and law enforcement authorities from any liability for any damages whatsoever for issuing this information. I authorize Camp KidJam to acquire background screening through a national background check agency. This information will be kept confidential and will be used for the sole purpose of providing a safe environment for camp participants. Should this application be accepted, I agree to be bound by the policies and procedures of Camp KidJam, and to refrain from unscriptural conduct, as determined by Camp KidJam in its sole discretion, in the performance of my services on behalf of this company. _________________________________ Applicant Signature _____________________________ Date _________________________________ Parent Signature (if applicant is under 18) _____________________________ Date
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