Mo-Ranch Summer Camp Summer Staff Application 1GENERAL INFORMATION2EDUCATION3CHURCH AFFILIATION4PAST EMPLOYMENT5EXPERIENCE6EMPLOYMENT QUESTIONS7MISCELLANEOUS INFORMATION8ACKNOWLEDGEMENTS9REFERENCES 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 applyHow did you hear about Mo-Ranch Summer Camp?* EDUCATIONSchool Attended*Please list the school, city, state, major subjects, dates attended and degree.Highest level completed by June 1, of this year?*Honors received (academic or other)* CHURCH AFFILIATIONDenomination*Place of Worship*City*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificActive Member?* Yes No How long?* PAST EMPLOYMENTPlease begin with current or most recent employment. Employer 1Employer NameEmployer AddressJob TitleDates of EmploymentSupervisor NameSupervisor TitlePhone NumberNature of WorkReason for Leaving Employer 2 Employer Name2Employer AddressJob TitleDates of EmploymentSupervisor NameSupervisor TitlePhone NumberNature of WorkReason for Leaving Employer 3 Employer Name3Employer AddressJob TitleDates of EmploymentSupervisor NameSupervisor TitlePhone NumberNature of WorkReason for Leaving Employer 4 Employer Name4Employer AddressJob TitleDates of EmploymentSupervisor NameSupervisor TitlePhone NumberNature of WorkReason for LeavingIf you are currently employed, may we contact your employer at this time for a reference?* Yes No EXPERIENCECamp ExperienceList your previous camp experience*Name the camp, location, year(s) attended and whether you were a camper or counselor. Skills Checklist Please rate your degree of skill on the checklist below. Add comments or detail if you have particular skills in an area. Rank according to the following criteria: 1 = Experienced leading/teaching skill 2 = Experienced in skill 3 = Some experience in skill 4 = No experience in skill LeadershipActivitiesBible Study*1234Initiative Games*1234Small Group Leader*1234Low Ropes*1234Worship Planning*1234High Ropes*1234Event Planning*1234Rock Climbing*1234 Wilderness SkillsAquaticsCamping*1234Swimming*1234LNT Ethics*1234Canoeing*1234Backcountry Cooking*1234Kayaking*1234Campfire Cooking*1234Fishing*1234Fire Building*1234Water Games*1234Environmental Ed.*1234 Health & SafetyArtsFirst Aid**1234Drama*1234Lifeguard***1234Dance*1234EMT*1234Singing*1234RN/LVN*1234Instrument*1234 SportsCraftsBasketball*1234Drawing*1234Tennis*1234Painting*1234Baseball*1234Pottery*1234Softball*1234Tie Dye*1234Soccer*1234Candle Making*1234Disc Golf*1234Leather Crafts*1234Archery*1234Nature Crafts*1234 ScienceLanguagesInsects*1234Spanish*1234Animals*1234French*1234Plants*1234 MiscellaneousGeology*1234Working with Children*1234Astronomy*1234Conflict Resolution*1234Meteorology*1234* 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.CertificationsPlease list any relevant certifications and expiration datesInclude certification, certifying body and expiration date. EMPLOYMENT QUESTIONS1. Why do you want to be a member of Mo-Ranch Summer Camps staff?*2. What experiences do you have with children ages 6-16? Be specific: describe the length of assignments and situations, as well as your specific responsibilities. Most importantly, what did you learn?*3. What types of leadership roles have you held? Again, be specific: describe the reasons you were chosen, the people you led, and what you learned.*4. Write a brief statement of faith. Describe the role that God plays in your life. What has been your past/what is your present involvement with the church? Describe any significant experiences in the past few years that have contributed to your growth as a person and as a Christian. Describe two or three qualities that should be most evident in a Christian’s life.*5. How does Mo-Ranch Summer Camps fit into your concept of Christianity? How can the camp experience enhance a camper’s faith? How can it enhance yours?*6. If you were asked to teach a 2-hour segment during staff orientation, what would you teach? Why do you think it would be important? What do you see as the benefits to such a class? (You do not have to be qualified to teach the topic.)* 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*CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
