Counselor Application

Counselor Application 2017
Full Name *

First Name Middle Name Last Name

Home Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

College Address (if applicable)

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Cell Phone *

- Area Code Phone Number
E-mail Address *
Birth Date *

Month Day Year
Social Security Number *
Sex *

Female Male
Marital Status *

Married Single
Are you currently taking any medications? *

Yes No
If yes, please list
Have you ever been accused of abusing a child? *

Yes No
Have you ever been convicted of a crime? *

Yes No
If you answered "yes" to either of the two previous questions please explain.
Give a testimony of your salvation: *
Have you read the camp's statement of Faith, (found on our website) and are you in agreement with it? If not please explain. *
Church Information:
Home Church *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Pastor: *
Pastor's Phone: *

- Area Code Phone Number
College Church

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Pastor:
Pastor's Phone

- Area Code Phone Number
What ministry (ies) are you currently involved in? Please list where and how you are involved. *
Do you believe and practice abstinence regarding sex before marriage? *

Yes No
Have you used tobacco or alcoholic beverages in the last 12 months? *

Yes No
Have you used any drug in an illegal way in the last 12 months? *

Yes No
List three positive personality characteristics that you possess: *
List three negative personality characteristics that you possess: *
Who is the most influential person in your life? Why? *
How do you respond when you are put under pressure? *
What are your vocational plans? *
What are your spare time interests and hobbies? *
Skills and Interest: (Check off any in which you have skill or ability) *

Canoeing Paintball Climbing Archery Crafts Nature Studies Swimming Drama Photography Riflery Other option
Music
Do you sing? *

Yes No
Do you play an instrument? *

Yes No
If yes, What instrument(s)?
Have you ever lead worship? *

Yes No
If yes, Where and When?
Camp Background:
What camps have you attended as a camper? *
What camps have you volunteered or worked at? *
Work Experience:
Please list your previous work experience starting with the most recent. *
Reference Information:
References should be adults who know you well, one should be your pastor, youth pastor, or a youth leader. Other references should be adults qualified to share an evaluation of your Christian life, character and work ethic.

References should be not be family members. After completing this application please have your references complete the online reference form. You can find the link on our website.
Reference 1 *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number
Relationship to you: *
Reference 2 *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number
Relationship to you: *
Reference 3 *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number
Relationship to you: *
By signing below, I hereby voluntarily authorize New Life Island to obtain the necessary background checks needed for lawful employment as a person having contact with children in the state of Pennsylvania. I also hereby give permission for those listed as my references to supply any and all information needed by the camp in the process of this employment application.
Signature

Clear
Should be Empty:

Counselor Application 2017

Church Information:

Music

Camp Background:

Work Experience:

Reference Information: