TPCC Application

Application

Name

Date of Application

Address

City

State

Zip

Primary Phone #

Secondary Phone #

Birthday

E-Mail Address

Driver’s License #

State

Parent/Guardian’s Name

Relationship

Parent/Guardian’s Name

Relationship

Emergency Contact’s Name

Relationship

Church Membership

Pastor

Church Address

City

State

Zip

Church Phone #

Education Information

High School

City/State

Graduation (date/year)

Colleges or Universities Attended

Major

Minor

Please list clubs, activities, athletics, or honors (include leadership roles)

Please list Christian organizations, ministries and church involvement (include leadership roles)

Employment Information

List current and/or previous places of employment and any employer you do NOT wish for us to contact, and why.

Employer

City/State

Phone #

Dates

Position

Reason for Leaving

List work experience related to camp or missions. Include volunteer work as well as lifeguard or ropes course certifications.

Camp/Mission

City/State

Phone #

Director’s Name

Position/Responsibilities

General Information

1) Please share your personal Christian testimony and include: (a) your life before Christ (b) how you came to faith (c) your personal growth and life since that time.

2) What do you feel are the important functions of a Christian camp and how would you be able to contribute to these functions?

3) How would you describe your ability to accept supervision?

How would you describe your ability to accept the restrictions of camp staff life?

How would you describe your ability to work with your peers?

How would you describe your ability to work with children?

Health Information

Do you have the ability to perform job-related functions such as lifting, carrying, walking, and other medium to heavy labor?

Yes No

Explain

If you have a disability or impairment, describe how with or without reasonable accommodations you would be able to perform job-related functions.

Please list any allergies that may limit your ability to work at camp (outdoors, with food, housekeeping).

Is there any reason, including physical or mental health related, that might affect your ability to work with, care for, or supervise children? If so, please explain.

Background Information

Have you been accused or convicted of crime(s) other than traffic violations in the past 10 years?

Yes No

Explain

Have you ever been accused or convicted of a crime in which a child was the victim?

Yes No

Explain

Have you ever been criminally charged with any crime related to the mistreatment, abuse or molestation of children?

Yes No

Explain

Have you ever been accused of harassment of any person, including, but not limited to, sexual, racial, or religious?

Yes No

Explain

References

Pastor

Name

Phone #

Address

City

State

Zip

Email

Other Christian Leader

Name

Phone #

Address

City

State

Zip

Email

Present/Former Employer

Name

Phone #

Address

City

State

Zip

Email

Present/Former Employer

Name

Phone #

Address

City

State

Zip

Email

Other

Name

Phone #

Address

City

State

Zip

Email

Other

Name

Phone #

Address

City

State

Zip

Email

Authorization

Authorization Statement

I authorize TPCC to obtain information from references, employers and churches listed herein. I also authorize any references, churches or other organizations, to release listed in this application to TPCC any information, including opinions that they may have regarding my character and fitness for the job I am applying. In consideration of the receipt and evaluation of this application by TPCC, I hereby release TPCC, any individual, church, children's organization, charity, employer, reference, or any other person or organization, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs or family, on account of compliance or any attempts to comply, with this authorization. I waive any right that I may have to inspect and/or obtain information provided about me by any person or organization identified by me in this application. I understand that TPCC desires to protect its guests and visitors and therefore give my permission for TPCC leadership to conduct a criminal background check and to maintain my fingerprints and photo ID on file. I further state that I have carefully read the foregoing release and know the contents thereof; and sign this release as my own free act. I understand that any misrepresentation or omission of a material fact in my application may be justification for refusal to employ me or termination of my employment.

Signature (type full name)

Typing your full name acts as your signature.

Date

Parent/Guardian Signature (if a minor)

Date

Signature is required to complete the application. Application will be valid for 90 days. If no decision is made by the camp within 90 days, another application should be completed and submitted if employment is still desired.