Personal Information

Name

First Name

Last Name

Phone

(###)

###

####

Sex

Date of Birth

YYYY

Mailing Address

Permanent Address (if different than mailing address)

What position are you applying for?

Shirt Size

Are you a Christian?

Are you a church member?

Church Name

Include City

List any other games/activities you can lead or assist in leading.

List any current certifications and the expiration date.

Lifeguard, EMT, CPR, etc.

Education

High School Attended/Attending

Grade Completed in May

College(s) Attended/Attending

Years Attended

Courses/Subjects

Activities

Degree(s) Earned

Work Experience

List employment beginning with current or most recent. Give as much information as possible. It is up to you to help us contact these employers.

1) Employer/Company

Supervisor

First Name

Last Name

Phone

(###)

###

####

Dates of Employment

Job Duties

Reason for Leaving

2) Employer/Company

Supervisor

First Name

Last Name

Phone

(###)

###

####

Dates of Employment

Job Duties

Reason for Leaving

3) Employer/Company

Supervisor

First Name

Last Name

Phone

(###)

###

####

Dates of Employment

Job Duties

Reason for Leaving

References

List 4 references (not related to you or each other). Provide all the requested information. An incomplete reference will disqualify your application.

1) Pastor or Church Staff Member

Name

First Name

Last Name

Phone

(###)

###

####

2) BSU Director or Sunday School Teacher

Name

First Name

Last Name

Phone

(###)

###

####

3) Adult Friend

First Name

Last Name

Phone

(###)

###

####

4) School Teacher or Faculty Advisor

First Name

Last Name

Phone

(###)

###

####

Emergency Contacts

1) Name

First Name

Last Name

Relationship

Phone

(###)

###

####

2) Name

First Name

Last Name

Relationship

Phone

(###)

###

####

Please answer the following questions in paragraph form in the box below.

Answer each question carefully.

a. Share your personal testimony and experience with Jesus Christ. b. How have you shared your faith with others? c. State your concept of the role of a staffer at Camp Lakeside. d. Why do you want to be a staffer at Camp Lakeside? e. What are your beliefs and practices related to alcohol, drugs, and tobacco products? f. List your personal strengths and weaknesses. Be honest! g. What previous experience do you have with children and youth? What are your future vocational plans? h. Write a brief biographical sketch. i. Tell me about your church “back home” and “at school” and how you are involved. j. List any additional information about yourself that you feel is applicable.

Please check the "I Agree" box if you agree with the following statement.

Rumors, backbiting, and unresolved inter-personal issues soon tear apart the people of God. Matthew 18:15-17 is clear about how to handle disagreements, misunderstandings, and troubled feelings. Do you agree to talk only with the person/persons who have offended you about the offense and not talk to anyone else about the offense until you have worked through the problem in the proper biblical steps?

I Agree

I Do Not Agree

Do you agree to welcome a person that you have offended who comes directly to you to resolve the issue and if the issue is not resolved, proceed through this biblical process?

I Agree

I Do Not Agree

Will you abstain from the use of alcohol, smoking, and drugs from the date your employment at Camp Lakeside begins through the date your employment terminates?

I Agree

I Do Not Agree

Are you willing to avoid extremes in dress and appearance and avoid practices that may be divisive or stumbling blocks to others?

I Agree

I Do Not Agree

If hired by Camp Lakeside, will you seek to be an example of biblical Christian living throughout your period of employment?

I Agree

I Do Not Agree

I understand that a criminal records check will be done on all applicants including charges of sexual offenses.

In compliance with federal law, the policy of the North Central Baptist Association is to hire only citizens of the United States and legally authorized aliens. All applicants who are hired will be required to complete an Employment Eligibility Verification Form (1-9) and provide the following documentation: (1) a United States passport or (2) a state issued driver's license and original Social Security card. I authorize investigation of all statements contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. Further, I understand and agree that my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without previous notice. I believe my responses in this application are a fair and clear statement of my situation, feelings, and beliefs at the present time and that I am fitted for service at Camp Lakeside in the position applied for.

By typing my name below, I agree this serves as my electronic signature.

Date you can begin work

YYYY

LABORCHEX INC.

AUTHORIZATION TO PROCURE A CONSUMER REPORT OR INVESTIGATIVE CONSUMER REPORT

The following person is seeking immediate employment and has Fully and Legally Authorized you to provide employment information.

Full Name

I HEREBY authorize North Central Baptist Association or those authorized by them to procure consumer reports and/or investigative consumer reports on me in connection with my application for employment or any time during my employment, which shall be used solely for the purpose of evaluating me for employment, promotion, reassignment, or retention as an employee or as an independent contractor. I understand that reports may include information about my prior employment, D.O.T. commercial driver experience as outlined in Parts 382.413, 391.23 and 391.25 of the Federal Motor Carrier Safety Regulations (FMCSRs), drug screening and testing, driving records, military record, education, credit worthiness and history, character, general reputation, criminal record, and mode of living, residency, general reputation, personal characteristics, performance, experience, reasons for termination of past employment and other qualities pertinent to my qualifications for employment. I understand that this information may be obtained through a variety of sources, including, but not limited to, public records, educational institutions, financial institutions, credit bureaus, consumer reporting agencies, and personal interviews with my current and former employers, friends, neighbors and associates. I understand that upon written request to the Human Resources Manager, [ Client Name] I will be informed whether an investigative consumer report was requested and given information as to the nature and scope of the investigation requested. I understand that upon written request to the Human Resources Manager, [Dr. Lowell Ingram] , a copy of this Authorization will be provided to me.

By typing my name below, I agree this serves as my electronic signature.

IDENTIFICATION INFORMATION

Other names I have been known by or worked under (for example, birth name; names by marriage, divorce, or adoption; or other name changes, etc.)

Race

Sex

Date of Birth

YYYY

Social Security Number

Current Home Address

City/State/Zip

Previous Home Address

City/State/Zip

EXACT Name on Drivers License

Driver's License Number

Driver's License State

Disclosure Statement

By this document, North Central Baptist Association discloses to you that a consumer report regarding your credit history, criminal history, employment drug testing and other background information and/or an investigative consumer report containing information as to your character general reputation, personal characteristics and/or mode of living may be obtained from consumer reporting agencies, personal interviews or other sources in connection with your application for employment or any time during your employment (including independent contractor assignments, as applicable). The information obtained shall be used solely for the purpose of evaluating you for employment, promotion, reassignment, or retention as an employee or independent contractor. All terms are used as defined in the FCRA, 15 U.S.C. § 1681 et seq.

Counselor Application

Counselor Application

Camp Lakeside

at Lakeside Baptist Assembly

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Questions?