All Fields marked with a * are required.

If you are unable to answer a required field please type n/a in the blank.

First Name	*
Middle Name
Last Name	*
Gender	*	Male Female
Date of Birth	*
Current Address (include city, state, zip)	*
Permanent Address (if different from above)
Cell Phone
Phone	*
Email	*
School Name	*
Year (freshmen, sophomore, etc.,)
Major
Present Occupation / Employer	*
Social Security #	*
Do you have a valid Driver's License?	*	Yes No
License ID#	*
State	*	- - Choose One - - - - US States - - AL AK AZ AR CA CO CT DC DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY - - Canada Provinces - - AB BC MB NB NL NT NS NU ON PE QC SK YT
Expiration Date	*
Home Church	*
Pastor's Name	*
Church Address	*
Church Phone	*
How did you learn about staff opportunities at Camp JIM?
.................................................................................................................Ministry History.................................................................................................................
What has the Lord been teaching you the past year?	*
In what ways were you challenged to change last summer and how did you implement those changes?	*
Why do you want to be a part of the summer staff this year?	*
Do you have any concerns about returning this summer?	*
..................................................................................................................References..................................................................................................................
APPLICANTS PLEASE NOTE:
Three references MUST be submitted in addition to this application. Please do not use close family members, such as parents or grandparents as references. We cannot process your application until all three of your references are in. YOU CAN HAVE YOUR REFERENCES FILL OUT A FORM AT http://campjim.org/?201200006 OR SEND THEM A FORM WITH A POSTAGE PAID ENVELOPE ADDRESSED TO CAMP JIM, 1026 Camp JIM Road SW, Pillager, MN 56473. Reference forms are available online at http://campjim.org/?201200006 or upon request.
Pastoral Reference (From your Senior Pastor, Youth Pastor, or youth sponsor):
Name	*
Phone	*
Chruch	*
Email	*
Address	*
Work Reference (From someone you have worked for who can comment on your work habits):
Name	*
Phone	*
Email	*
Address	*
Character Reference (From an adult who knows you well and can comment on your character/personal qualities):
Name	*
Phone	*
Email	*
Address	*
......................................................................................................Personal History and Health....................................................................................................
Have you ever...
Been involved with drugs and alcohol?	*	Yes No
Been convicted of physical or sexual abuse?	*	Yes No
Been convicted of any crime, felony or misdemeanor?	*	Yes No
Do you have any physical limitations that require special attention?	*	Yes No
Explain any “yes” answers to the questions above:
A summer staff position is emotionally and physically demanding. Staff are required to participate in activities with campers and need to be able to keep a close watch over the campers in their charge. Are you aware of any reasons you would not be able to fulfill the essential functions of a position you are requesting?	*	Yes No
If so, please explain:
How would you combat emotional, physical and/or spiritual exhaustion if on Camp JIM’s staff?	*
.........................................................................................................................Skills........................................................................................................................
Ball Field Games		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Camping/Nature Skills		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Group Activities		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Nature Activities		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Archery		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Music Skills (please list)
Carpentry		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Cleaning / Upkeep		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Dishwashing		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Small Engine Repair		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Canoeing		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Fishing		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Swimming		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Air Rifles		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Drama		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Audio / Visual		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Photography / Video		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Kitchen Help		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Climbing		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Challenge Course		-----Choose One----- No Experience Some Experience I am skilled in I am able to teach
Licenses / Certificates
EMT	*	Yes No
Expiration Date
First Aid	*	Yes No
Expiration Date
Advanced First Aid	*	Yes No
Expiration Date
CPR	*	Yes No
Expiration Date
WSI	*	Yes No
Expiration Date
Lifeguard	*	Yes No
Expiration Date
.............................................................................................................Summer Commitment...........................................................................................................
POSITION DESIRED: If applying for more than one position, please indicate order of preference (1st, 2nd, etc.)
1st Preference	*	----------Choose One---------- Cabin Counselor Maintenance/Custodian* Lifeguard Head Cook CIT Coordinator Worship Team Coordinator Nurse Other
2nd Preference		----------Choose One---------- Cabin Counselor Maintenance/Custodian* Lifeguard Head Cook CIT Coordinator Worship Team Coordinator Nurse Other
3rd Preference		----------Choose One---------- Cabin Counselor Maintenance/Custodian* Lifeguard Head Cook CIT Coordinator Worship Team Coordinator Nurse Other
If you selected other for any of the preferences above please list the position you would like to apply for
If you selected Nurse above please select your certification		RN LPN Other
* Note: some machinery/equipment requires applicant be 18 years of age or older.
SUMMER STAFF ARE EXPECTED TO BE AT CAMP FROM JUNE 7th - July 27th.
June 7th - 16th Staff Training (attendance required)
June 17th - 19th Cub Camp Grades 1-3
June 23rd - 29th Sr. High Camp Grades 9-12
June 20th - July 2nd Family Camp All ages
July 7th - 12th Junior Camp Grades 3-5
July 14th - 19th Intermediate Camp Grades 5-7
July 21st - 27th Junior High Camp Grades 7-9
Do you anticipate any conflicts during your term of employment?	*	Yes No
If yes, please list dates and reason:
..............................................................................................................Statement of Faith.............................................................................................................
1. We believe the Bible to be the inspired, the infallible, authoritative word of God.
2. We believe that there is one God, eternally existent in three Persons: Father, Son and Holy Spirit.
3. We believe in the deity of our Lord Jesus Christ, in His virgin birth, in His sinless life, in His miracles, in his vicarious and atoning death through His shed blood, in His bodily resurrection, in his/ ascension to the right hand of the Father, and in His personal return in power and glory.
4. We believe that for the salvation of lost and sinful men, regeneration by the Holy Spirit is absolutely essential.
5. We believe in the present ministry of the Holy Spirit by whose indwelling the Christian is enabled to live a godly life.
6. We believe in the resurrection of both the saved and the lost; they that are saved unto the resurrection of life and they that are lost unto the resurrection of damnation.
7. We believe in the spiritual unity of believers in Christ.
....................................................................................................................Agreement....................................................................................................................
I agree with the above Statement of Faith, and I understand that because Camp JIM is an non-denominational camp and does not wish to offend other believers, I will agree to refrain from teaching or discussing doctrinal issues (such as baptism, communion, end times, speaking in tongues, etc.) about which evangelicaldenominations may hold differing views.
I hereby certify that the information I have given in this application is accurate and factual to the best of my knowledge.
I hereby give permission to Camp JIM to publish photographic, video images, and recordings of the applicant for promotional purposes.
If accepted for a summer staff position at Camp JIM, I will abide by the expectations, policies, and principles, both verbal and written asked of me and will accept my proper responsibilities as a member of the camp community. It will by my chief aim to make the Lord Jesus Christ real in the lives of campers as they see Christ in me. I understand that disregarding of any of the above may result in my dismissal from camp staff. I further understand that Camp JIM’s Director or myself may terminate this employment agreement at any time for any reason.
I hereby authorize Camp JIM to contact all prior employers, any references listed herein and law enforcement (background checks by a second party) to verify all information provided and to obtain any and all information related to my character and past work performance. I further hereby release all prior employers and references from any liability for information provided in good faith.
Signature	*
Date	*
If the applicant is under 18 years of age, either a parent or guardian must sign below. Your signature indicates that this application is made with full approval on your part and signifies your permission for the applicant to complete the necessary application, child protection forms and interviews. This also authorizes camp to transport you child off camp to camp approved camp functions.
Signature
Date
Sec Code	*