Summer Camp Health Officer Form
Quaker Haven Camp & Retreat Center is looking for a Summer Camp Health Officer to oversee the health of the youth campers, and camp staff, provide first aid, respond to emergencies on camp, and participate with other staff to provide the fun, nurturing environment that kids love. (This is an approximate 7 week position.) 

Quaker Haven Camp is a Christian camp!  Our summer staff is made up of committed Christians who have the heart to serve. Our camping programs can only be as good as our staff; therefore, we focus on selecting the best staff possible. Because of the huge expectations placed on our summer ministry team, we are careful to select staff members who are dedicated to Christ, not only in camp, but also in their everyday lives. 
Email *
First Name *
Last Name *
Birth Date  *
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Email *
Gender *
Address *
T-Shirt Size (adult sizes) *
Name of College Attending  *
What are your qualifications? (check all that apply) *
Required
Employment History
List your last two (2) employers or volunteer activities, starting with the most recent 
Employment History #1- Employer, Dates Worked, Address, Supervisor Name, Phone Number, Email, Job Title, Reason For Leaving *
Employment History #2- Employer, Dates Worked, Address, Supervisor Name, Phone Number, Email, Job Title, Reason For Leaving *
Which camps are you available? (check all that apply) *
Required
Please Provide Us With Three References Below 
List referents who are not related to you and whom you have known for at least six (6) months 
Academic Reference:  Please Provide First & Last Name, Phone Number, Email, Relationship, and How long you have known them. *
Character Reference: Please Provide First & Last Name, Phone Number, Email, Relationship, and How long you have known them. *
Pastoral Reference: Please Provide First & Last Name, Phone Number, Email, Relationship, and How long you have known them. *
How did you learn of Quaker Haven Camp? Have you ever been a camper here or elsewhere? 
 *
Describe how your relationship with Jesus Christ began and what it is like today. 
 *
Verification
I hereby authorize Quaker Haven Camp to contact all prior employers, secure a criminal background check, and contact any references listed to verify all information provided.  

I also authorize QHC to obtain all information related to my character and past work performance.  I further hereby release all references and prior employers from any liability for information provided in good faith. I affirm that I have neither been convicted of, nor am I the subject of pending charges for, any offense involving actual or attempted child abuse or sexual molestation in any jurisdiction.  I understand that, and grant permission, Quaker Haven Camp may secure a background check from state and national databases prior to employment. 
I understand that the Quaker Haven Foundation Board requires that employees do not smoke, partake of alcoholic beverages, or use narcotics of any kind. 

I hereby affirm and acknowledge, by signing immediately below, that all the information provided and all of my answers to the foregoing questions are true and complete, and that any misrepresentation or omission maybe grounds for rejection or, if later employed, dismissal. 

Health Officer applicants must show proof of First Aid / CPR Training or equivalent 
Required Signature  *
Notice to Applicants: 
 Federal and State law requires that all applications be considered without regard to race, religion, age, or national origin.  We believe and fully support that principle of equal opportunity. 
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