Applicant's Name *

First Name

Last Name

Position Preference: *

Please check the position(s) you are interested in. Please be sure to read position descriptions on the Staff Information Sheet as some have changed.

Activities Assistant

Assistant Nurse

Bible Teacher

Counselor/Companion

Housekeeping

Lifeguard

Support Staff

If necessary, are you willing to serve in ANY position for which you are qualified, even if it is not checked above? *

YES

NO

Staff Orientation Availability *

Please see the "LOCATIONS AND DATES" section of the Staff Information Sheet. Compare the Handi*Camp dates to any commitments already on your personal calendar before filling out the sections below. This information is helpful to us as we consider all of our applicants and it in no way obligates the Handi*Camp organization or you. Each staff member, with the exception of nurses, is expected to attend Orientation. There is very little time to communicate the information that is crucial to serving our campers in the best and safest way possible. Certain sessions are required, depending on the position for which you are applying. We will consider each case individually if you are applying and unable to attend portions of Orientation.

I am able to attend ALL of Staff Orientation. (AM June 4 - PM June 7)

I am only able to attend SOME of the Staff Orientation time. (please list when you will be there below)

I cannot attend Staff Orientation.

Please check which week(s) you are interested in serving: *

June 8-10: Challengers - Session 1

June 12-14: Challengers - Session 2

June 19-21: Explorers

June 26-28: Voyagers

June 29 - July 1: Adventurers

July 3-5: Seekers

July 6-8: Discoverers

July 10-12: Conquerors and YABC

REFERENCE 1 - Name of Pastor, Youth Pastor or Church Leader: *

First Name

Last Name

Reference 1 - Mailing Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference 1 - Home/Cell Phone:

(###)

###

####

Reference 1 - Work Phone:

(###)

###

####

REFERENCE 2 - Name:

First Name

Last Name

Reference 2 - Mailing Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference 2 - Home/Cell Phone:

(###)

###

####

Reference 2 - Work Phone:

(###)

###

####

REFERENCE 3 - Name:

First Name

Last Name

Reference 3 - Mailing Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference 3 - Home/Cell Phone:

(###)

###

####

Reference 3 - Work Phone:

(###)

###

####

REFERENCE 4 - Name of Employer:

First Name

Last Name

Reference 4 - Mailing Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference 4 - Home/Cell Phone:

(###)

###

####

Reference 4 - Work Phone:

(###)

###

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Date of hire:

MM

DD

YYYY

Employment end date: (if applicable)

MM

DD

YYYY