Summer Staff Re-Employment Application 1GENERAL INFORMATION2EDUCATION3CHURCH AFFILIATION4PAST EMPLOYMENT5CERTIFICATIONS6EMPLOYMENT QUESTIONS7MISCELLANEOUS INFORMATION Applicant:* First Last Date of Application* MM slash DD slash YYYY Home Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone:*Personal Email:* Your School Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your School Phone:*Mo-Ranch Summer Camps provides campers the opportunity to grow in their faith by experiencing the love of God through relationships grounded in Christian faith, living in a community and playing and learning in our beautiful outdoor setting.Position Applying for:*CounselorHead Counselor/DCHead Counselor/SCLeadership DirectorMedia CounselorSelect all that apply PAST EMPLOYMENTPlease begin with current or most recent employment. Employer 1Employer Name Employer Address Job Title Dates of Employment Supervisor Name Supervisor Title Phone NumberNature of Work Reason for Leaving Employer 2 Employer Name2 Employer Address Job Title Dates of Employment Supervisor Name Supervisor Title Phone NumberNature of Work Reason for Leaving Employer 3 Employer Name3 Employer Address Job Title Dates of Employment Supervisor Name Supervisor Title Phone NumberNature of Work Reason for Leaving Employer 4 Employer Name4 Employer Address Job Title Dates of Employment Supervisor Name Supervisor Title Phone NumberNature of Work Reason for LeavingIf you are currently employed, may we contact your employer at this time for a reference?* Yes No CERTIFICATIONSCertificationsPlease list any relevant certifications and expiration datesInclude certification, certifying body and expiration date.* Current CPR & First Aid certifications are required by the beginning of camp. **Current Lifeguard certification is highly recommended for all summer camp counselors. Applicants are encouraged to obtain these certifications before the start of Staff Orientation. If demand is high enough, Mo-Ranch may offer a Lifeguard certification course one week prior to Staff Orientation, and/or a CPR & First Aid certification course the weekend before Staff Orientation. EMPLOYMENT QUESTIONS1. Describe a situation that you remember well from the last summer you worked as a Summer Camp Staff. What did you learn from that event? How do you expect this event to influence you in the future?*2. What do you believe were your greatest strength and weakness from the last summer you worked as a Summer Camp Staff? How do you expect to use or overcome these traits in the future?*3. What is the one thing you enjoyed the most about your last experience at Mo-Ranch Summer Camp? The least? Do you anticipate these to be present again this year?* MISCELLANEOUS INFORMATIONDate(s) previously worked at Mo-Ranch:* Beginning and Ending datesWhat position(s) did you hold?* Having read the job description, are you able to perform the functions of the job for which you are applying?* Yes No If no, please attach an explanationWill you be able to support the Mission Statement of Mo-Ranch and goals of Mo-Ranch Summer Camps?* Yes No If no, please attach an explanationHave you ever been convicted of a misdemeanor or felony, other than traffic violations, in this state or in any other state? (Note: Information regarding convictions will not necessarily bar an applicant from employment)* Yes No If yes, please attach an explanationHave you ever been disciplined or fired?* Yes No If yes, please attach an explanationDo you have any judgments or legal actions against you at the present time?* Yes No ACKNOWLEDGEMENTSDRUG TESTING NOTICE TO APPLICANTS*It is the policy of Presbyterian Mo-Ranch Assembly to maintain a work environment free from the use of illegal drugs. In order to commence employment, applicants who are offered a position must submit to drug screening by urinalysis. Applicants whose drug test results indicate the presence of more than a trace of any illegal drug or controlled substance will not be hired. Due consideration will be given, however, to applicants taking medication under prescription. If you have questions concerning this policy, ask the person to whom you submit your application. I have read, or had read to me, and understand the above and acknowledge and accept the above. I agree Name* By typing your name, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.Email* Acknowledgment*By providing my legal name, email address, and electronic signature above, I confirm that I have read, or had read to me, and understand the above and acknowledge and accept the above. Confirm REFERENCESThree completed reference forms must be returned directly to Mo-Ranch Summer Camps by references. At least 1 personal and 1 professional reference are Required. The reference form is available here in the form of a pdf file that can be attached and send to each reference via email.Reference 1Name* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email* Relationship* Reference 2Name* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email* Relationship* Reference 3Name* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Number*Email* Relationship* CAPTCHANameThis field is for validation purposes and should be left unchanged.
