Summer Camp Staff
Application
Name: _______________________________________
Camp Yavapines
Summer 2015
Our goals are to:
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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:
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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__________________