Summer Staff Application 2017
For any questions regarding this application:
Phone: 276-328-6876 (office) 1-800-359-4049 (toll free)
Email: info@campbethel.com
Your Full Name
First Middle Last
Your answer
Date
Your answer
Date of Birth
Your answer
Age
Your answer
Gender
Permanent Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Preferred Mailing Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Cell Phone
Your answer
Email
Your answer
EDUCATION INFORMATION
Choose which grade will be completed by June 2017
High School
College
Post Grad
GPA
Your answer
School / Dates Attended / Major / Degree (if applicable)
Your answer
School / Dates Attended / Major / Degree (if applicable)
Your answer
MEDICAL INFORMATION
**Your insurance will be considered primary and Camp Bethel's will be secondary (only in applicable situations)
Insurance Company
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Name of Policy Holder
Your answer
Policy #
Your answer
Group #
Your answer
Phone
Your answer
In case of emergency, please notify
Your answer
Relationship
Your answer
Phone
Your answer
OR Notify
Your answer
Relationship
Your answer
Phone
Your answer
Please list any current medications
Your answer
Please list any allergies
Your answer
Please list HEALTH RELATED dietary needs
Your answer
List any serious illnesses/ injuries/ surgeries you've had in the last 2 years
Your answer
Do you have any medical/ physical restrictions that would limit your performance in the job for which you have applied?
If yes, please specify
Your answer
Do you (or anyone in your family) have a history of any of the following? (check all that apply)
Required
List any other pre-existing conditions or other information
Your answer
Are you prone to any of the following (check all that apply)
Have you ever received medical treatment for nervous breakdown or other mental health disorders?
If yes, please specify
Your answer
Have you receveied the MMR immunization?
Have you receveied the Tetanus immunization ?
Date of Tetanus
Your answer
FAMILY BACKGROUND
Father/Guardian in Home
Name
Your answer
Relationship
Your answer
Father/Guardian's Occupation
Your answer
Mother/Guardian in Home
Name
Your answer
Relationship
Your answer
Mother/ Guardian's Occupation
Your answer
Are your parents/ guardians born again believers?
Do they attend church reguarly?
If yes, what denomination do they associate with?
Your answer
CHRISTIAN FELLOWSHIP
Are you a member of a church?
Name of Church
Your answer
City, State
Your answer
Pastor's Name
Your answer
Name of church PRESENTLY attending
Your answer
City, State
Your answer
Pastor's Name
Your answer
How often do you attend?
Your answer
List any involvement in Christian organizations (FCA, Young life, etc.)
Your answer
PERSONAL TESTIMONY
**THE FOLLOWING MUST BE COMPLETED BY THE APPLICANT
Describe how, when and where you accepted Jesus Christ as your personal Lord and Savior
Your answer
What steps would you use to lead a camper to Christ?
Include Bible verses to support
Your answer
BIBLE KNOWLEDGE
Using BIBLE VERSES as support and YOUR OWN WORDS, briefly describe the following subjects
The Trinity
Your answer
The Virgin Birth
Your answer
Death, Burial and Resurrection of Jesus
Your answer
Salvation
Your answer
Speaking in Tongues
Your answer
Explain what 2 Timothy 3:16 means
Your answer
Once you are saved, are you always saved or can you lose your salvation?
Your answer
PLEASE COMPLETE THE FOLLOWING PRAYERFULLY. WE WANT TO KNOW HOW YOU HONESTLY FEEL, NOT WHAT YOU THINK WE WANT TO HEAR
Why do you want to work at Camp Bethel?
Your answer
What struggles have you had since accepting the Lord as Savior?
Your answer
Describe your personal prayer time and Bible study
Your answer
Are you currently memorizing Scripture on a regular basis?
Your answer
Do you feel it is acceptable to date a non-Christian?
Your answer
What are your thoughts on the following?
Sex before marriage?
Your answer
Drugs/Tobacco (any form)
Your answer
Movies/ TV/ MTV
Your answer
Music (types you like/ dislike, etc.)
Your answer
Homosexuality
Your answer
PREVIOUS CAMP EXPERIENCE
Camp Name
Your answer
Dates
Your answer
Attended or Worked?
Your answer
Positions/Duties
Your answer
Camp Name
Your answer
Dates
Your answer
Attended or Worked?
Your answer
Positions/Duties
Your answer
PREVIOUS WORK EXPERIENCE
Employer
Your answer
Dates
Your answer
Address and Phone #
Your answer
Position/Duties
Your answer
Employer
Your answer
Dates
Your answer
Address and Phone #
Your answer
Position/Duties
Your answer
REFERENCES
These people need to be familiar with your character and qualifications. We may contact them. Your signature on the final page is your authorization for release of information to them.
Previous Employer
Your answer
Position
Your answer
Phone
Your answer
School Professional
(teacher, counselor, etc.)
Your answer
Position
Your answer
Phone
Your answer
Spiritual Reference
(Pastor, Assistant Pastor, Youth Leaders, etc.)
Your answer
Relationship
Your answer
Phone
Your answer
In what position(s) are you interested in serving?
Mission Staff reserves the right to assign you to the position best suited for overall
Required
Please provide us with information on why you feel qualified to fill the positions checked.
Your answer
SKILLS
Please check all CURRENT certifications held (must be up to date)
Do you have any musical talent?
Required
If instrumental, what instrument?
Your answer
Can you swim?
CLASSES
Cabin Leader age staff will be asked to teach or assist in the recreation classes listed below. To let us know how you can help, please choose either teach, assist or interest.
Archery
Drama
Mountain Boarding
Rock Climbing
Softball/Baseball
Arts and Crafts
Flag Football
Musical/Vocal
Ropes Course
Swimming
Basketball
Media
Paintball
Skateboarding
Volleyball
Canoeing
Mountain Biking
Riflery
Soccer
Wilderness Survival
If you circled teach, please state your qualifications to teach that class
Your answer
STATEMENT OF FAITH
Camp Bethel believes:
- In the entire Bible as the inspired Word of God

- In the one triune God - Father, Son, and Holy Spirit

- That man is totally depraved and in need of salvation

- That salvation is by grace through faith, and is made possible because of the virgin birth, death, burial, and bodily resurrection, and ascension of Christ Jesus

- That the Holy Spirit indwells in each believer, and that the believer's life is to be yielded to Him

- That the believer is kept by the power of God and thus is secure in Christ now and for eternity

- In eternal life with God for the saved and eternal punishment in hell for all who reject Jesus Christ

- In the personal, imminent return of our Lord and Savior Jesus Christ

I have read and agree with the Camp Bethel Ministries Statement of Faith
Signature / Date (Type Below)
Your answer
I have read and DO NOT agree with the Camp Bethel Ministries Statement of Faith
Signature / Date (Type Below)
Your answer
Please state the reason for your disagreement here
Your answer
Summer Commitment
All summer staff members are required to attend orientation unless other arrangements have been made with the camp director. Orientation is especially important for potential cabin leaders. Please check all dates you will be able to serve this summer. (If you work less than 5 weeks, you will be considered a volunteer).
*Additional weeks to serve available
Required
Weekends off begin Saturday after all work is completed and end on Sunday at 5:00PM. Any change in time of departure or return must be approved by the camp director. You are allowed two weekends off. Please list below the weekends you will be requesting off (subject to approval).
Your answer
Please read and initial each statement
I am willing to serve wherever I am assigned and I am willing to perform all assigned tasks, regardless of how insignificant they seem, to the best of my ability.
Your answer
I am willing to actively and enthusiastically support all of the programmed activities, including but not limited to team games and competition, skits, morning exercises, etc.
Your answer
If accepted for a position, I will follow all rules and regulations of the camp, as listed in the staff manual. I understand that failure to abide by the rules may result in my immediate dismissal.
Your answer
I am willing to submit to those in authority over me, including my peers that may be placed in authority over me.
Your answer
I agree to submit to a drug test if needed.
Your answer
I commit to work the entire summer, with the exception of approved time away at the discretion of the Camp Director.
Your answer
For applicants under 18 years of age
Parents please read the following before signing: The health information and history is correct as far as I know and the above applicant has my permission to engage in all prescribed camp/staff activities. If I cannot be reached in an emergency, I hereby give permission to Camp Bethel to secure proper medical treatment. I have read the application, I agree to the background check if needed.
Signature / Date
Your answer
All other applicants
I verify that the information provided on this application is true and correct to the best of my knowledge. I understand that I will be working under supervision of the Camp Bethel Staff and I am subject to the rules and regulations of the camp. I promise to obey all of the Camp Bethel rules, day and night, and I understand that I will be sent home if I fail to do so.
Signature / Date
Your answer
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