Application and Release Form for Employees
Please fill out this form as accurately as possible. If you do not believe that a response is applicable, put “not applicable” in the blank.
Personal Information
Name
*
Maiden Name
First Name
Middle Name
Last Name
Birth Date
*
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1921
1920
Year
Gender
*
Please Select
Male
Female
N/A
Age
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Mobile Number
*
Height
*
Weight
*
T-Shirt Size
*
Please Select
Small
Medium
Large
X-Large
XX-Large
XXX-Large
XXXX-Large
List all of your social media handles:
*
Date of Last Tetanus:
*
-
Month
-
Day
Year
Date
Marital Status
*
Spouse’s Name (if not applicable, put N/A in both boxes)
*
First Name
Last Name
Spouse’s Phone Number
Please enter a valid phone number.
Please list any and all chronic conditions you may have:
*
Is there any health related reason that would prevent you from effectively working in an active camp environment or cause potential harm to our campers?
*
Yes
No
If yes, please explain
*
Please list any medications and dosages you are currently taking
*
Food/ Drug Allergies
*
Health Insurance Carrier/ Policy #
*
Hospital Preference
*
Physician’s Name
Dr.
PA
NP
Prefix
First Name
Last Name
Physician’s Phone Number
Please enter a valid phone number.
Emergency Contact
*
First Name
Last Name
Contact’s Phone Number
*
Please enter a valid phone number.
Position Applying for
*
Please Select
Camp Counselor
Recreation Staff
Camp Cook
PRO (Returning Staff Only)
SOS (Returning Staff Only)
Date Available
*
-
Month
-
Day
Year
Date
Length of Commitment
*
CrossView Summer Staff must be available to work the entire summer schedule (besides weekends and Break Week which is the week of July 4). By marking below, you understand this requirement.
*
I understand and accept.
Employment History
List your current job first or most recent job if you are currently unemployed and then all others in reverse chronological order. Please list ALL former employment.
Employer - Supervisor - Dates of Employment - City - State - Phone Number
*
May we contact your current supervisor?
*
Yes
No
If no, please explain why
*
Education
What High School did you attend?
*
When did you attend?
*
Did you graduate?
*
Yes
No
When did you graduate?
*
-
Month
-
Day
Year
Date
Have you attended a college or university?
*
Yes
No
Name of School
*
Years attended
*
Did you graduate?
*
Yes
No
Degree Recieved
*
Please describe below any skills, training, qualifications you possess which you believe would assist CrossView in its operation:
*
Are you CPR and/or First Aid Certified?
*
Yes
No
Expiration of Certification
-
Month
-
Day
Year
Date
Are you Lifeguard Certified?
*
Yes
No
Expiration of Certification
-
Month
-
Day
Year
Date
Are you able to lead worship?
*
Yes
No
Instrument(s)
*
Spiritual Life
What church/fellowship are you a member of?
*
How long have you attended that church?
*
Pastor's Name
*
First Name
Last Name
How often do you attend church?
*
Did/do you work with children at your church?
*
Yes
No
If you did/ do work with children there, describe what you did/do:
*
Please list any previous church service including name of church, full address, whether the position was volunteer or paid, and approximate dates of the service:
*
Do you consider yourself to be a positive role model for others?
*
Yes
No
Please explain why:
*
Please explain salvation as you understand it:
*
Have you accepted Jesus Christ as your Lord and Savior?
*
Yes
No
When?
*
-
Month
-
Day
Year
Date
Have you ever led another person to Christ?
*
Yes
No
Are you comfortable sharing the Gospel?
*
Yes
No
If no, why not?
*
Do you have personal "quiet time" or alone time with God on a regular basis?
*
Yes
No
Are you struggling with any addictions (self-harm, pornography, drugs, alcohol, etc)?
*
Yes
No
If yes, please explain
*
Personal Integrity/ Criminal History
Please provide the names and phone numbers of three personal references not related to you:
*
In order to be hired at CrossView Christian Camp, you will need to: 1)submit the fully completed application 2)turn in a letter of recommendation from one of your references by mail or email 3) be interviewed by the Executive Director in-person or via zoom.
*
I understand and accept.
Is there any reason, including those that are physical or mental health related, that might keep you from effectively working with children or that might cause a child potential harm?
*
Yes
No
Have you ever been charged with, indicted for, or plead guilty for a crime?
*
Yes
No
Have you ever been charged with, indicted for, or plead guilty to an action prohibited by the Texas Family Code, or a similar code in any state?
*
Yes
No
If "yes" to any of the above 3 questions, please explain:
*
If you've ever been known by any other names please list them below:
*
Are you willing to be fingerprinted and background checked by a national agency?
*
Yes
No
If no, why not?
*
Signature
*
Clear
Date
*
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Day
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Date
Signature
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Signature
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Signature
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Date
*
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Signature
*
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Date
*
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Date
Submit Application
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