Welcome to our online application! Please fill out this form if you are a NEW applicant or former
CIT applying for a paid position.

Volunteers and Returning staff - please fill out our abbreviated application Parents: To ensure proper screening and fair
representation, this application MUST be completed by the applicant. Applicant must also download and turn in 2 reference forms.

Statement of Practice

In order to safeguard the well-being of the guests served, Camp Berachah will investigate the accuracy of the data provided in the application process for all applicants before appointment to the camp staff can be made. This investigation will include, but is not limited to, reference checks to past employers, the military, educational institutions, volunteer organizations, civic groups, and law-enforcement agencies.

secured site

Position(s) Applied For:

Preference 1:

Preference 2:

Preference 3:

Times & Dates Available:

If part-time or volunteer, Days and times available:
Sun:	Mon:	Tues:	Wed:	Thur:	Fri:	Sat:
List times:
Date available: Start: End:

Salary Requirements:

Paid full-time	Paid part-time	Volunteer	Summer
Salary required:

Personal Information:

Name:		Telephone:
A.K.A:		Email:
Address:

How long at this address? From: To Present:

Previous Addresses (Past 10 Years):

1.

2.

How referred to Camp Berachah?

Do you drive?		License held/ #::
U.S.Citizen?		Visa Type, if not a citizen::

Birthdate:		Age:		Gender:
Marital Status:		Children:		Ages:
Housing Needs:

T-Shirt Size:

XS:

S:

M:

L:

XL:

XXL:

1. Do you have a personal relationship with Jesus Christ?		Please describe:
2. How often do you attend church?		Describe your involvement:
3. What is your church affiliation & Christian background experience (i.e. charismatic, traditional)
4. Describe your ministry experience. (i.e. leading bible study, worship, etc).

5. Please briefly describe what your beliefs are regarding the following subjects.
The Bible:		Tobacco/drugs/alcohol:
Salvation & how to lead a camper to Christ:		Body art/piercing:
Jesus Christ:		Pre-marital sex:
The Holy Spirit:		Homosexuality:
Gifts of Spirit:		Prayer:

Employment History

Employer #1	Dates Employed		Work Performed
	From:	To:
Address:
	Hourly Rate/Salary		Job Title: Supervisor:
Phone number:	Starting:	Final:	Reason for leaving:

Employer #2	Dates Employed		Work Performed
	From:	To:
Address:
	Hourly Rate/Salary		Job Title: Supervisor:
Phone number:	Starting:	Final:	Reason for leaving:

Summarize special job-related skills and qualifications acquired from employment, ministry or other experience:

Have you ever had any job-related training in the United States military?

If yes, please describe.

Special Skills & Qualifications List professional, trade, business, or civic activities and offices held. You may exclude organizations which indicate race, color, religion, gender, national origin, handicap or other protected status.
	Specialized training, apprenticeship, skills and extra-curricular activities:
	Honors you've received:
	State additional information you feel may be helpful:

Education

	Elementary/Jr. High	High School	College/University	Graduate School
School name:
Location:
Year Completed	N/A
Diploma/Degree	N/A
Course of study:	N/A

Additional Information:

Are you physically or otherwise unable to perform the duties of the job for which you are applying?:

If YES, please explain:

Have you ever been accused or convicted of any criminal offense?

If yes, explain:

Have you ever had DSHS or other childcare/adult contracts or licenses terminated or denied?

If yes, explain:

List two current references and their phone numbers and submit two completed reference forms:

1.

2.

Applicant's Statement: I certify that the answers given herein are true. I authorize a government background check and investigation of all statements contained in this application for employment. In the event of employment, I understand that false or misleading information given in my application or interview may result in discharge.


Signature/Name	Date

Thank you for your interest in Camp Berachah Ministries!