Camp Akita RETURNING STAFF Application- Summer 2021

Returning Staff Application

Summer Camp 2021
Full Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
DOB *

Month Day Year
Please select one *

Male Female
T-Shirt Size *
Jacket Size *
Cell Phone *

Area Code Phone Number
E-mail *
Are you a U.S Citizen? *
If No, please provide work authorization A#:
In the past year have you ever been arrested and/or convicted of a crime involving drugs, sex, or violence? *
If Yes, please explain:
Current Occupation: *
Supervisor's Name
Supervisor's Phone:
Are you a Seventh-day Adventist? *
Church name: *
Pastor: *
Your Address At School *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Major:
Minor:
Next Year's school plan: *
Grade: *
Thinking back to last summer, how would you describe your growth experience?
How have you ben growing in your spiritual journey since camp?
How can leadership pour into you as a staff member, but also individually as a person?
Please List Three (3) references. (These individuals must not be related to you).
1. Name *

First Name Last Name
Position: *
(Pastor, Teacher/Dean, Work Supervisor)
Email: *
Phone # *
2. Name *

First Name Last Name
Position: *
(Pastor, Teacher/Dean, Work Supervisor)
Email: *
Phone # *
3. Name *

First Name Last Name
Position: *
Email: *
Phone # *
Is there anything that could hinder your work performance at camp (including health issues) *
If Yes, Please explain:
Present Health Condition: *
POSITION: Please list your first three job choices in order of preference, including qualifications and experiences, that would make you suitable for each positioned desired.
Previous Position: *
1st Desired Position: *
Qualification/ Experience: *
2nd Desired Position: *
Qualification/ Experience: *
3rd Desired Position: *
Qualification/ Experience: *
Are you willing and able to commit a full seven (9) weeks to summer camp? *
If "No", please explain:
Skills:

Have you earned a new skill or certification during the year that you did not posses during camp last year?
If so, Please describe: *
Which Certification(s) do you posses?
Archery
Expiration Date

Month Day Year
CHA
Expiration Date

Month Day Year
CPR
Expiration Date

Month Day Year
Food Service
Expiration Date

Month Day Year
LIfe Saving
Expiration Date

Month Day Year
Lifeguard Instructor
Expiration Date

Month Day Year
Rock Climbing
Expiration Date

Month Day Year
WSI
Expiration Date

Month Day Year
Positions: *

Archery Instructor Canoeing Instructor Climbing wall/Rappelling Instructor Counselor/Sub Counselor Craft Instructor Horse Wrangler/Horsemanship Instructor Kitchen/Food Service Staff Lifeguard/Swimming Instructor Maintenance Mountain Biking Instructor Tubing Instructor/Watercraft Driver Boat Driver
If you are under 18 years of age, your parent or legal guardian must sign.

I hereby give permission for my child to work and reside at Camp Akita for the summer of 2020. I give my child permission to travel as necessary with other staff members for programs/events as required by the Director.
Parent or legal guardian's Name

First Name Last Name
Date

Month Day Year
Confirmation of Applicant
Signature

Clear
Date: *

Month Day Year
Should be Empty:

Returning Staff Application

Confirmation of Applicant