application - Kellogg Springs Camp & Conference Center

Summer Staff Application

Personal Information

Name *
Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Cell Phone *
Email *
Emergency Contact *
Emergency Contact Phone *
Gender *
Date of Birth *mm/dd/yy
Year of School *
T-Shirt Size *

Summer Programs

What are you applying for? *

Health

Is there any reason that you would have difficulty performing any camp related task? For example: Do you have a reason you can't stand for hours at a time? Do you have a reason you can't walk up and down hills all day?
YesNo
If yes, please explain

Education (High School)

Name of High School *
City/State of High School *
Year of Graduation *Or year of expected graduation

Education (College)

Name of College or University *reply "n/a" if not applicable
City/State of College or University
Year of Graduation Or year of expected graduation

Background

Are you a US Citizen? *
If you are not a U.S Citizen, please list the country you are a citizen of:
Have you ever been convicted of a felony, child abuse or unlawful sexual offense? *

Employment History

Please list your last three employers, or volunteer service. Start with your most recent.

Employer #1

Employer *reply "n/a" if not applicable
Dates of employment Example; July 2005 to May 2008
Title example; dishwasher, laborer. etc.

Employer #2

Employer *reply "n/a" if not applicable
Dates of employment
Title

Employer #3

Employer *reply "n/a" if not applicable
Dates of of employment
Title

References

Before your application can be completely processed, we need at least 3 references from people who are not related to you, who are at least 5 years older than you, and who have known you for longer than 1 year. See application page for more info.

Reference #1

Reference Name *
Relationship example; youth pastor, supervisor, personal, etc.
Phone
Email

Reference #2

Reference Name *
Relationship
Phone
Email

Reference #3

Reference Name *
Relationship
Phone
Email

Getting to Know You

Please answer the following questions.

Describe your personal spiritual journey, please include things like how you became a Christian and how the Lord is involved in your everyday life. *
What do you think kids should experience at camp? *
What goals do you wish to pursue this summer and how will you pursue these goals? *
Job Preference There are many jobs around camp - Mark the ones you are most interested in.

Skills

Please check the appropriate boxes below.

Rock Climbing
Archery
Zipline
Kitchen Experience
Housekeeping Experience
Mentoring Others
Lifeguard
Maintenance
Please expand on any experience that you have that you think would be beneficial at Kellogg Springs Camp.
If you have experience mentoring others, please use this text box to expand on your experience and how you could help our summer staff interns be successful this summer.

Time Off

Do you have any dates that you will need time off for? For example: family vacation, High School Camp, etc.
Are you available to start working earlier? (Begining as early as late May)
If you are applying to be a counselor or for the 2-4 week program, which dates/camps are you available?
OrPac Kids Camps: Kids Camp 1 - July 11-14, Kids Camp 2 - July 15-18, Kids Camp 3 - July 19-23
Do you have any food allergies that we should know about?
File Upload You can upload a resume or letter if reference if you would like.

Verification

Please enter any two digits *Example: 12
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