2025 New Summer Staff Application

New Staff Application Black Lake Bible Camp
Full Name*

First NameLast Name
E-mail*
Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Best time of day to reach you?
Gender*

MaleFemale
Marital Status*

SingleMarried
What position are you applying for?*
What is your 2nd choice (different) *
What is your 3rd choice (different) *
Please list any date(s) you anticipate you will not be able to work and the reason WHY. (Note: Time off during the summer will be a rare thing, few exceptions will be made. If hired you will be expected to work the duration of your contract. Please reference the summer calendar in the staff packet)*

Emergency Contacts - you must list at least two, minors MUST list parent(s)/guardian first.
1) Name*
Relationship*
Phone Number*
2) Name*
Relationship*
Phone Number*
3) Name
Relationship
Phone Number
4) Name
Relationship
Phone Number
Medical Insurance Information (BLBC is a secondary insurance provider only)
Insurance Policy*
Policy #*
Group #*
Doctor's Name*
Phone Number*
Will you bring a car?*

YesNoDon't Know
Drivers License #
Present Occupation or year in school*
High School Name*
City
Year of Graduation*
College name
City
Year of graduation
Vocational school
City
Year of graduation

Home Church*
Pastor's name*
Church phone number*
How often do you attend?*
List any other groups, Bible studies, or ministries you are currently a part of
Any other certifications that would be relevant to the positions you are applying for.

How did you hear about BLBC?*
List any camp ministry work experience you may have.*
What experience do you have working with children?*
Yes or No, have you ever committed an act of abuse or violence against a child, peer, or adult? If yes, please explain.*
List your hobbies
Do you play an instrument or sing?*

YesNo
Which one(s)
List any leadership experience, honors, awards, etc..

You must provide three adult references that we can email the reference form to. Youth/College Pastor or Pastor is required to be at least one reference. Relatives cannot be used as a reference unless you have been an employee for them. Other people that would be good references are teachers, coaches, mentors, and small group leaders.
First Reference
Pastor/Youth Pastor's first name*
Last Name*
Email Address*
Phone #*
What is your relationship?*
Second Reference
First name*
Last name*
Email address*
Phone #*
What is your relationship?*
Third Reference
First name*
Last name*
Email address*
Phone #*
What is your relationship*
Authorization
The facts set forth in this application and any supplemental information is true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be considered sufficient cause for immediate discharge. I hereby authorize investigation of all statements contained herein and employers listed above to give you any and all information concerning my employment, and any pertinent information they may have, and release all parties from all liability for any damage that may result fromfurnishing same.

I understand that I am required to abide by all rules and regulations of Black Lake Bible Camp.
Signature*
Date*
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New Staff Application Black Lake Bible Camp