Camp and
VOLUNTEER COUNSELOR/PROGRAM STAFF APPLICATION
Full Legal Name: ______________________________________________Maiden Name: ________________
Current Address: ___________________________________________________________________________
City:
Driver’s License Number:
Other addresses used in past 3 years:____________________________________________________________
__________________________________________________________________________________________
Phone (day): (_____) _______________________ (evening): (_____) _______________________
Email address: ____________________________________ Date of Birth (if under 21): ____/____/____
Pastor:
For which Sierra Pines camps do you wish to volunteer (please check the camps that apply)?
_____ Middler Sierra Summer Camp
_____ Junior Sierra Summer Camp
_____
Junior Snow
_____ Junior High Sierra Summer Camp
_____ Junior High Snow Camp
_____ Senior High Sierra Summer Camp
_____ Senior High Snow Camp
I desire to volunteer as a camp counselor or other program staff position (i.e. director, music leader, speaker, crafts person, etc.) because: ________________________________________________________________________________________
__________________________________________________________________________________________
List previous
__________________________________________________________________________________________
List previous experience working with children/youth: _____________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Volunteer Counselor/Program Staff Application Page 2
List any special skills, talents and interests that relate
to camping (i.e. crafts, sports, singing, playing an instrument, lead group
games, etc.):
________________________________________________________________________________________
_________________________________________________________________________________________
Briefly explain your Christian faith and relationship with Jesus Christ: _________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
What positive contributions can you make as a camp staff
member at Sierra Pines? ______________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Have you ever been convicted of any crime against children
or other persons? __No ___Yes, explain: _______
_________________________________________________________________________________________
Have you ever been found in any dependency action to have
sexually assaulted or exploited any minor or to have physically abused any
minor? ___No ___Yes, explain: ________________________________________
_________________________________________________________________________________________
Have you ever been found by a court in a
domestic relations proceeding to have sexually abused or exploited any
minor or to have physically abused any minor?
___No ___Yes,
explain: __________________________
_________________________________________________________________________________________
Have you ever been convicted of a felony or of any crime for
which you have served a jail or prison sentence? (Omit references to
convictions under Health and Safety Code sections 11357(a) or (b), 11360(c),
11364, 11365, or 111550 related to marijuana which occurred two or more years
ago and any post-trial diversion program.) ___No ___Yes, explain:
_____________________________________________________________
_________________________________________________________________________________________
Are you currently awaiting trial for any criminal offense?
___No ___Yes, explain: _______________________
_________________________________________________________________________________________
Please list three personal (not related) references having knowledge of your character, experience, and ability.
One reference should be your pastor, youth pastor or a church leader.
Please have each reference return a reference form to Sierra Pines to complete the application process.
Name How
Does This Person Know You? Phone
#
1._________________________________________________________________(_____)________________
2._________________________________________________________________(_____)________________
3._________________________________________________________________(_____)________________
I authorize the investigation of all statements herein, including a complete background check by law enforcement agencies, and release the camp and all others from liability in connection with the same. I understand that untrue, misleading or omitted information herein my result in dismissal, regardless of the time of discovery.
Signature: ______________________________________________________________ Date: _____________
Reference Check for
1. Please submit letters from at least three persons. You can bring them instead of mailing them to camp but you MUST bring to camp to counselor. If you have already submitted letters, there is no need for others unless any information in application has changed.
2. At least one of the persons should be the person’s pastor and/or youth pastor.
(You may cut on the lines and give to references)
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Questions to answer: Please answer the questions, place in a sealed envelope with your name, address, phone number, and relationship to the counselor.
a. How long have you know this person?
b. In what relationship have you know this person?
c. What is their relationship with Christ?
d. What experience does this person have working with the ages of the campers your will lead?
e. How well do they relate to that age group?
f. How well do they work with other adults who are working with this age group?
g. How well do they take suggestions and direction?
h. If you had a child the age group of the camp session that this person will be working with, would you want your child to be under the leadership of this person?
I. Has this person ever been accused or charged with child abuse?
j. What else is important for us to know about this person?
k. If you feel you need to talk with someone
else, call
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Questions to answer: Please answer the questions, place in a sealed envelope with your name, address, phone number, and relationship to the counselor.
a. How long have you know this person?
b. In what relationship have you know this person?
c. What is their relationship with Christ?
d. What experience does this person have working with the ages of the campers your will lead?
e. How well do they relate to that age group?
f. How well do they work with other adults who are working with this age group?
g. How well do they take suggestions and direction?
h. If you had a child the age group of the camp session that this person will be working with, would you want your child to be under the leadership of this person?
I. Has this person ever been accused or charged with child abuse?
j. What else is important for us to know about this person?
k. If you feel you need to talk with someone
else, call
------------------------------------------------------------------------------------------
Questions to answer: Please answer the questions, place in a sealed envelope with your name, address, phone number, and relationship to the counselor.
a. How long have you know this person?
b. In what relationship have you know this person?
c. What is their relationship with Christ?
d. What experience does this person have working with the ages of the campers your will lead?
e. How well do they relate to that age group?
f. How well do they work with other adults who are working with this age group?
g. How well do they take suggestions and direction?
h. If you had a child the age group of the camp session that this person will be working with, would you want your child to be under the leadership of this person?
I. Has this person ever been accused or charged with child abuse?
j. What else is important for us to know about this person?
k. If you feel you need to talk with someone
else, call