DRIVERS LICENSE

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					                               2012 SWC STAFF APPLICATION

NAME___________________________EMAIL_________________________________

ADDRESS_____________________________________________________________

PHONE(___)_______________________OCCUPATION:__________________

                       AGE:_____________          D.O.B.____________        SEX: M/F        marital
status: M/S

DRIVERS LICENSE#            _______-________-_______-________

SS#________-_______-________                            CELL#(____)__________________

HOME PHONE#(_____)________________WORK#(____)_______________

EMERGENCY CONTACT#(____)_____________________


SPIRITUAL LIFE:       HOME CHURCH:___________________________

HOW LONG SAVED:________________

CAMP EXPERIENCE HAVE YOU BEEN A CAMPER? Y/N YEAR:________

PERSONAL LIFE: PARENT/GUARDIAN/SPOUSE NAME:_____________________

                               CONTACT PHONE (____)_____________________

PRIOR WORK HISTORY

EMPLOYER:_________________________PH.#(_____)_____________


state required questions:
Have you ever been convicted of anything other than a monor traffic violation? N/Y (explain on
back)
Are you currently being treated for any infectous deseases?
N/Y (explain on back)
Are you currently infected with communicable tuberculosis?                             N/Y (explain
on back)
Are there any health concerns we should know about?                                    N/Y (explain
on back)
REFRENCES: (signatures of your pastor/youth pastor and TWO other NONrelated persons
required.)
“Having confidence in this applicants ability inqualifications of eduction, training and Christian
maturity/experience, I recommend the consideration of his/her application as staff for SWC. I
further believe this individual has the appropriate character and emotional stability to serve the
staff positon and age level for which he/she applied.

1. Name:__________________________________

church:______________________________city:___________________
             (pastor/youth pastor signature)

 church phone: (____)___________________
             (above printed name)
2.Name:___________________________________ phone(____)________________

address:____________________________________________________

3. Name:___________________________________phone(___)_________________

address:________________________________________________

If applicant is a MINOR, please complete: “I authorize the camp to consent to emergency
medical or surgical treatment of my child, and to routine, non-surgical medical care. I also agree
to pay for the performance of such treatment, anesthetics, and operations as deemed
necessary in the opinion of the attending physician.” Printed name of parent, legal guardian, or
authorized person:

_______________________________________________

Signature of above named:__________________________________________

insurance co.______________________

Policy#_______________________________

Disclamer: Pending funds available, staff expenses will be covered. As a extra precaution,
please ask your church to sponser your week at SWC.

*This application must be postmarked by July 1st*
*MAIL application to Eagles Nest church 620 east 4th st. Monroe, Mi. 48161
Questions: CALL Gen. Louie 734-241-1502
Applicant’s Commitment: I pledge myself to a week of cooperative ministry and will maintain a
personal discipline and spirit that exemplifies Christ at all times. I will make the physical, mental
and spiritual welfare of the campers my first priority. I will attend the Staff Orientation, which is
required by State Law, on the Sunday prior to my week of service. I authorize a criminal
background check and verification of information provided.

Applicant’s Signature___________________________________

date:_______________________

MEDIA by signing form you agree to allow us to use any media coverage
taken during event for future promotions and publications.
Thank you

				
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