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