Application - Camp Yavapines
Summer Camp Staff Application Name: _______________________________________ Camp Yavapines Summer 2015 Our goals are to: Connect each camper with Jesus. Ignite their active love for Him. Forge them into spiritual leaders who will share the Good News of Jesus. Staff Qualifications: Have a daily growing relationship with Jesus Christ. Be able to communicate Christ as a personal Savior and loving friend to both campers and staff. Have a positive attitude with an ability to fulfill responsibilities. Work as a team player. Be kid-focused and have a desire to see them accept Jesus as their Savior. Be in good health and vitality. Be able to take directions and implement advice. Be FLEXIBLE! We will only contact you if you meet our criteria and an opening becomes available. Generally, those who are 18 yrs and above will be considered for employment, however, you are welcome to apply even if you are under this age. Arizona Conference of Seventh-day Adventists Camp Yavapines 2999 W. Iron Springs Road - Prescott, AZ 86305 Phone: 928-445-2162 Fax #928-445-8043 Email: [email protected] FOR OFFICE USE ONLY Applicant Name ___________________________ Date Application Received _____/_____/________ Type Position _____________________________ Date Interviewed __________________________ PERSONAL Name _________________________________________________ Age ________ Soc. Sec. # ___________________ Home Address ____________________________________________________________________________________ School Dorm Address _______________________________________________________________________________ Phone ___________________________________________ Mobile _________________________________________ T-shirt size (circle) S M L X XXL Marital Status: Single ___ Married ___ Divorced ____ Current occupation or work __________________________________________________________________________ Supervisors _______________________________________________________________________________________ School offices and responsibilities held _________________________________________________________________ School you will attend next year ________________________________________ Grade next year ________________ Are you SDA? Yes ____ No ___ Home Church ______________________________ Pastor _______________________ What commitments do you have for next summer? (engagement, marriage, wedding, vacations, family plans, etc.) _________________________________________________________________________________________________ CAMP EXPERIENCE For which staff position are you applying? (Please list in priority) 1. ______________________________________ 2. ______________________________________ 3. ______________________________________ What are your qualifications for these positions? 1. _____________________________________________________________________________________________ 2. _____________________________________________________________________________________________ 3. _____________________________________________________________________________________________ Have you ever been a camper? _________ If yes, where? _________________________________________________ Please list any paid camp staff experience: Where: ___________________________ Position: ____________ Year: _________ Camp Director: ______________ Where: ___________________________ Position: ____________ Year: _________ Camp Director: ______________ Where: ___________________________ Position: ____________ Year: _________ Camp Director: ______________ HEALTH Your present health: Excellent ___ Good___ Fair ___ Poor___ Last injury or surgery: _______________________________________________________________________________ List any allergies: ___________________________________________________________________________ Do you have any physical handicaps? _________________________________________________________________ Who should be contacted in case of emergency? ________________________________________________________ Name: _____________________ Relationship:________________ Phone: ______-______-_______________ SKILLS AND INTERESTS Arts and Crafts Circle (1 for interest, 2 for knowledge, 3 for skill) Waterfront Miscellaneous Ceramics 1 2 3 Canoeing 1 2 3 Braiding 1 2 3 Swimming 1 2 3 Indian Lore 1 2 3 Springboard Diving 1 2 3 Leather Craft 1 2 3 W.S.I. 1 2 3 Pottery 1 2 3 Sculpturing 1 2 3 Soap Craft 1 2 3 Weaving 1 2 3 Safety Basic Rescue 1 2 3 CPR 1 2 3 First Aid 1 2 3 Certified Life Guard 1 2 3 Music Camp Songs 1 2 3 Song Leading 1 2 3 Special Music 1 2 3 Instruments __________ 1 2 3 Other skills and interests we should know about: __________________________________________________ __________________________________________________ __________________________________________________ __________________________________________________ Programming Devotional Talks 1 2 3 Group Games 1 2 3 Skits/Plays 1 2 3 Puppets 1 2 3 Archery 1 2 3 Mountain Biking 1 2 3 Horsemanship 1 2 3 Go Kart/Auto Mechanics 1 2 3 Gymnastics 1 2 3 Camping Skills Rock Climbing/ Rappelling 1 2 3 Camp Cookery 1 2 3 Fire Building 1 2 3 Zip Line 1 2 3 Hiking 1 2 3 Mountain Boarding 1 2 3 Knots 1 2 3 Orienteering 1 2 3 Disc Golf 1 2 3 Tent Camping 1 2 3 Other _____________ 1 2 3 Other _____________ 1 2 3 SPIRITUAL SELF-EVALUATION Excellent Above Average Average Below Average Regularly Occasionally Rarely Not a Practice I perceive my spiritual condition as My teachers perceives my spiritual condition as My best friends perceive my spiritual condition as: My spiritual involvement is: Please give examples: ______________________________ _________________________________________________ CHRISTIAN BEHAVIOR I have prayer and devotions I am involved in outreach activities * I attend Sabbath School and Church My use of tobacco or alcohol is: * Please specify or add your comments: ________________________________________________________________ UNLAWFUL CONDUCT Have you been (formally or informally) accused, charged or disciplined for any unlawful sexual conduct, child abuse, and/or child sexual abuse? Yes ___ No___ Have you been (formally or informally) accused, charged or disciplined for use of any illegal drugs? Yes___ No___ Signed ______________________________________ Date _____________________ PATHFINDER INVOLVEMENT Were you a Pathfinder? Yes___ No___ What is the highest Pathfinder class completed? __________________ List as many Pathfinder Honors earned as you can remember (use backside if necessary) _________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Any outstanding Pathfinder experiences? _______________________________________________________________ _________________________________________________________________________________________________ Complete each statement: “I want to work for Camp Yavapines because… ___________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ “I believe the aim and purpose of a summer camp should be … _____________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ How and why did you become a Christian? ______________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ What makes your lifestyle as a Christian unique? _________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ How do you personally maintain a daily relationship with Jesus? ____________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ RECOMMENDATIONS Please list the individuals who will be sending in your recommendation forms (not a relative): 1. Name: ________________________________________________ Phone: ________________________ Address: _______________________________________________ Position: _______________________ 2. Name: _________________________________________________Phone: ________________________ Address: _______________________________________________ Position: _______________________ 3. Name: _________________________________________________Phone: ________________________ Address: _______________________________________________ Position: _______________________ Optional Information: Date of Birth _____________________________ Thank you for your candid responses. This information is confidential, and is intended to be reviewed only by the hiring personnel. Yavapines Staff Emergency Form Name:____________________________________ Age:_______ Gender:__________ Birth Date:________________ City:_______________ State:_______ Zip:_________ Home Phone: ___________________ Mobile Phone: __________________ Emergency Contact Information 1. Name:______________________________ Relationship: ________________________ Home Phone: ________________________ Mobile Phone: _______________________ 2. Name: _____________________________ Relationship: ________________________ Home Phone: ________________________ Mobile Phone: _______________________ Insurance Information Primary Insurance Carrier: _______________________ Policy Holder’s Name: __________________________ Policy Number: ________________________________ Group Number: ________________________________ Allergies (medication, food, animals, etc.) and reaction: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Current Prescription Medications: ___________________________________________________________________________ ___________________________________________________________________________ Medical Conditions (Anemia, High Blood Pressure, Hearing Loss, Asthma, Diabetes, etc.) ___________________________________________________________________________ ___________________________________________________________________________ Signature___________________________________________Date__________________
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