PO BOX 428 6993 Hickory Nut Gap Rd Banner Elk, NC 28604 info@HolstonCenter.org www.HolstonCenter.org

Summer Staff Employment Application

Applicant Information

Full Name:	Date:
Last	First	M.I.

Address:
Street Address	Apartment/Unit #

City	State	ZIP Code

Phone:	Email
Age:

Date Available:	Social Security No.:	Desired Salary:	$

Position Applied for:

Are you a citizen of the United States?	YES	NO	If no, are you authorized to work in the U.S.?	YES	NO

Have you ever worked for this company?	YES	NO	If yes, when?

Have you been convicted of a felony?	YES	NO

If yes, explain:

Do you have a valid driver’s license?	YES	NO	Do you have a chauffeur’s license?	YES	NO

Education

High School:	Address:

From:	To:	Did you graduate?	YES	NO	Diploma::

College:	Address:

From:	To:	Did you graduate?	YES	NO	Degree:

Other:	Address:

From:	To:	Did you graduate?	YES	NO	Degree:

References

Please list three professional references.

Full Name:	Relationship:
Company:	Phone:
Address:
Full Name:	Relationship:
Company:	Phone:
Address:
Full Name:	Relationship:
Company:	Phone:
Address:

Previous Employment

Company:	Phone:
Address:	Supervisor:

Job Title:	Starting Salary:	$	Ending Salary:	$

Responsibilities:

From:	To:	Reason for Leaving:

May we contact your previous supervisor for a reference?	YES	NO

Company:	Phone:
Address:	Supervisor:

Job Title:	Starting Salary:	$	Ending Salary:	$

Responsibilities:

From:	To:	Reason for Leaving:

May we contact your previous supervisor for a reference?	YES	NO

Company:	Phone:
Address:	Supervisor:

Job Title:	Starting Salary:	$	Ending Salary:	$

Responsibilities:

From:	To:	Reason for Leaving:

May we contact your previous supervisor for a reference?	YES	NO

Activity Experience

What contributions do you think you can make at camp?
What contributions do you think you can make at camp?
Write a brief biographical sketch, including specialized training in camping, and experience or training in other fields which might have a bearing on the position(s) for which you are applying.
Holston is a Christian Camp. We espouse Christian values at camp. Comment on your spiritual life, Christian values and how you hope to share your beliefs with young people.

In the following list, put numeral “1” before those activities you can organize and teach as an expert; “2” for those activities in which you can assist in teaching; and, “3” for those which are just your hobby.

Adventure/Challenge	Pioneering	Nature	Sports	Waterfront
Climbing/Rappelling	Hiking	Animals	Archery	Canoeing/Kayak
Ropes course	Orienteering	Astronomy	Basketball	Lifeguard
Spelunking	Outdoor cook	Birds	Fishing	Swim Instructor
Arts and Crafts	Overnight	Conservation	Games	Miscellaneous
Ceramics	Backpacking	Flowers	Paint Ball	First Aid
Jewelry/Beads	Knot tying	Forestry	Soccer	CPR
Macramé	Music	Insects	Volleyball	Campfire Program
Nature Crafts	Lead singing	Rock Mineral	GaGa ball	Gardening
Painting/Drawing	Guitar	Trees	4 Square	Storytelling
Photography	Dancing	Weather	Track/field	Worship Service
Dramatics	Line	Gardening
Directing	Contra	Animal Care
Skit Organize	Square

Indicate how many years as camper or scouting experience?

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

I authorize investigation of all statements herein and release the camp and all other from liability in connection with same. I understand that, if employed, I will be an at-will employee and that any agreement to the contrary must be in writing and signed by the Director of the Camp. I also understand that untrue, misleading, or omitted information herein may result in dismissal, regardless of the time of t discovery by the camp.

Signature:	Date:

All statements become part of any future employee personnel files.