Application Form

Remember neatness counts; grammar, punctuation, and spelling are important in making a good first impression.

PERSONAL INFORMATION
 
 
(include area code)
 
 
 
 
 
 
Date of Birth:
Day Month Year  
 
 
What is your highest level of education completed?  
EMPLOYMENT HISTORY(check if unemployed)
Current Employer
Supervisor
Address
(include area code)
Start Date of Employment: Month Year  
Duties Performed

Previous Employer Supervisor
Address Telephone (include area code)
Start Date of Employment: Month Year  

Duties Performed


Reason for leaving

CHURCH LIFE
Are you a Christian?
What church are you a member of?
Pastor's name
Address
City State Zip code  

QUALIFICATIONS
Do you have a good work ethic?
Are you willing to endure long hours and the Texas summer heat?
Are you willing to share the load and help others?

Are you certified in either of the following?
lifeguard
ropes course facilitator

Do you consider yourself a positive role model for children? Yes No
How did you hear about Camp Copass?
Why do you want to be a summer staffer at Camp Copass? Be specific.
CHARACTER REFERENCES
All references will be contacted so you must provide complete information. Your application will not be processed otherwise.
Name Telephone number (include area code)
Name Telephone number (include area code)
Name Telephone number (include area code)
LEGAL INFORMATION
Because Camp Copass cares for children and young people and desires to protect them we ask you to please answer the following questions. We understand that the following questions are personal and we will protect your privacy.

Are there any reasons, including those that are physically or mentally health related, that might keep you from effectively working with children or youth, or that might cause a child potential harm? Yes No

Have you ever been charged with, indicted for, or pled guilty to a crime? This does not include traffic citations. Yes No

Have you ever been charged with, indicted for, or pled guilty to an action prohibited by the Texas Family Code, or a similar code in any state? Yes No

Have you ever been known by any other legal name (including maiden)?

List all other names:

Would you be willing to be fingerprinted? Yes No

If you were personally a victim of child abuse we require that you make it know to the Camp Administrator. Admitting you were a victim will not automatically disqualify you from service. Your confidence will be respected and appreciated.

The information contained in this application is correct to the best of my knowledge. I authorize Camp Copass to obtain information from references and churches listed herein. I also authorize any references or churches listed in this application to give you any information, including opinions that they may have regarding my character and fitness for Christian camp work. In consideration of the receipt and evaluation of this application by Camp Copass, I hereby release 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 any information provided about me by any person or organization identified by me in this application. Should my application be accepted I agree to be bound by the Bylaws and Policies of Camp Copass and to refrain from unscriptural conduct in the performance of my services on behalf of the camp. I understand that Camp Copass desires to protect those who use their facilities and therefore give my permission for the Camp Administrator to conduct a criminal background check on me. 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 have read the camp staff rules

I will add Camp Copass as a friend on Facebook for full profile reviewing purposes.
Yes No


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