Social Security #

Drivers License # / State

Email

Relationship to Parent/Guardian

Relationship

Church Membership

Pastor

Education Information

High School

City/State

Graduation

College/Universities Attended - Dates Attended - Degrees/Hours Completed

Major

Minor

Please list clubs, activities, athletics, or honors. Include leadership roles:

Please list Christian organizations, ministries and church involvement. Include leadership roles:

Employment Information

List current and/or two previous places of employment as well as any employer you DO NOT wish for us to contact, and why.

Employer

City/State - Phone # - Dates - Position - Reason for Leaving

Employer

City/State - Phone # - Dates - Position - Reason for Leaving

List work experience related to camp or missions. Include volunteer work as well as lifeguard or ropes course certifications

Camp/Mission - City/State - Phone # - Director's Name - Position/Responsibilities

1.) Please share your personal, Christian testimony and include:

a) Your life before you placed your trust in Christ

b) How you came to faith

c) Your personal growth and life since that time

2.) What do you feel are the important functions of a Christian camp and how would you be able to contribute to these functions?

3.) How would you describe your ability to:

Accept supervision?

Accept the restrictions of camp staff life?

Work with your peers?

Work with children?

Health Information

Do you have the ability to perform job-related functions such as lifting, carrying, walking and other medium to heavy labor?

If you have a disability or impairment, describe or demonstrate how, with or without reasonable accommodations you would be able to perform job-related functions.

Please list any allergies that may limit your ability to work at camp (outdoors, with food, housekeeping):

Is there any reason, including those that are physical or mental health related that might affect your ability to work with, care for or supervise children? If so please explain:

Background Information

Have you been accused or convicted of crime(s) other than traffic violations in the past 10 years? If yes, explain:

Have you ever been accused or convicted of a crime in which a child was the victim? If yes, explain:

Have you ever been criminally charged with any crime related to the mistreatment, abuse or molestation of children? If yes, explain:

Have you ever been accused of harassment of any person, including, but not limited to, sexual, racial, or religious? If yes, explain:

References

Email

Authorization

I authorize TPCC to obtain information from references, employers and churches listed herein. I also authorize any references, church or organizations or employers listed in this application to give TPCC any information, including opinions that they may have regarding my character and fitness for the job I am applying. In consideration of the receipt and evaluation of this application by TPCC, I hereby release TPCC, any individual, church, children's organization, charity, employer reference, or any other person or organization, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply, with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application. Should my application be accepted, I agree to be bound by the Bylaws and policies of TPCC, which are adopted from time to time, and to refrain from unscriptural conduct in the performance of my services on behalf of TPCC.

I understand that TPCC desires to protect its guests and visitors and therefore give my permission for TPCC leadership to conduct a criminal background check on me and to maintain my fingerprints and photo ID on file. I further state that I have carefully read the foregoing release and know the contents thereof; and sign this release as my own free act. I understand that any misrepresentation or omission of a material fact on my application may be justification for refusal of employment or release from employment at any time.

In the event I am employed, I understand that all employees are subject to termination at the discretion of TPCC. If, in the event I choose to voluntarily terminate my employment, I am free to do so at anytime, and if I choose to give proper notice of termination, TPCC may either permit me to continue my employment during the notice period or may accept my resignation immediately. I understand that, in the event I am employed by TPCC, my compensation (if any), hours of service and all other terms and conditions of employment are subject to modification or change by TPCC at TPCC's discretion.

Signature

Parent/Guardian's Signature (If a minor)

Signature is required to complete the application. Application will be valid for 90 days. If no decision is made by the camp as to employment within 90 days, another application should be completed and submitted if employment is still desired.

Trinity Pines Conference Center

Summer Leader & full time Application