We, the administration of Tay Valley Bible Camp, make every effort to screen all staff members that work at the camp, to insure the welfare of all who attend. The lengthiness of this application is due to our efforts of precaution. Thank you for understanding.

Staff will be expected to attend staff orientation/training. In the event that you do not fulfill your original estimated stay at Tay Valley Bible Camp, you are expected to inform the directors two weeks in advance of your departure.

ATTENTION: Tay Valley Bible Camp staff are all volunteers.

PERSONAL INFORMATION
Name__________________________Birth Date_______/_____/______
Address:__________________________________________________
Marital Status______________________Gender___________________
Phone:________________________E-mail:______________________

EDUCATION
High School__________________________Year Completed__________
GED:_______________________________Year Competed__________
College_______________________Major____________Years________
Other Education / Certifications__________________________________

CHRISTIAN EXPERIENCE
Church Affiliation____________________Denomination______________

Please briefly answer the following questions:
1. When was the approximate date of your conversion?
2. How did you come to accept Christ as your Savior?
3. How do you know that you are saved?
4. Is Jesus Christ the Lord of you life?
5. What do you believe is God's will for your life at this time?

Which position(s) are you interested in applying for. (Explain why you believe you are qualified for this position)
~Activity Director_____________________________________
~Activity Assistant____________________________________
~Cook______________________________________________
~Kitchen Helpers_____________________________________
~Senior Counselor (boys)_______________________________
~Junior Counselor (boys)_______________________________
~Senior Counselor (girls)________________________________
~Junior Counselor (girls)________________________________
~Nurse / EMT_________________________________________
~Lifeguard____________________________________________
~Snack Shack________________________________________
~Special Music________________________________________
~Maintenance_________________________________________
~Other_______________________________________________

Please tell where you have volunteered in the past 5 years, especially where you have dealt with youth under 18 years of age. (Please provide Names, Dates, Addresses, Phone numbers):
______________________________________________
______________________________________________
______________________________________________
______________________________________________


Please rate your ability in the following areas, where
0=No Experience
1=Limited Experience
2=Considerable Experience / Skilled
_____Song Leading
_____Drama / Storytelling
_____Puppet Ministry
_____Guitar
_____Piano
_____Other Instrument________________
_____Campfires
_____Outdoor Cooking
_____Canoeing
_____Hiking / Backpacking
_____Swimming
_____Lifesaving
_____First Aid
_____Other___________________________________________

List all personal physical, mental, emotional, social, or spiritual conditions that could interfere with, or affect your performance as a Christian youth worker. (include allergies, chronic illnesses, handicaps, weaknesses, etc.)
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________

REFERENCES
Please list three persons not related to you:

Pastor_______________________Phone______________
Address_______________________________________

Employer_____________________Phone______________
Address_______________________________________

School reference / or Christian you have worked with:
Name________________________Phone______________
Address_______________________________________

State briefly why you believe God is leading you to work at
Tay Valley Bible Camp:
_____________________________________________
_____________________________________________
_____________________________________________
Are you willing to perform other job duties other than those you have indicated?
_____________________________________________
Are you willing to volunteer your service for NO FINANCIAL COMPENSATION?
_____________________________________________

MEDICAL INSURANCE
I am covered by Medicare Y____N____
Medicare #______________________Expiry Date____________
Family Physician________________Phone_________________
I am covered by medical insurance________________________
Name of company______________________________________
Policy #______________________Phone___________________

In case of emergency, call_______________________________
I plan to arrive at Tay Valley on (Date)______________________
I plan to depart Tay Valley on (Date)_______________________

COMMITMENT
With the Lord's help, I, _________________________________, agree to abide by the rules and regulations established by the management of Tay Valley Bible Camp during my employment at same. I agree to conduct myself in a good, moral, and Christian manner at all time, whether in camp, or out. I will do my best to always have a good attitude and do all my duties without complaint. I will purpose above all else to keep God first, others second, and myself last.

DISCLAIMER / RELEASE
In the event of an accident or sickness, I _______________________, hereby release Tay Valley Bible Camp, Tay Valley Evangelistic Association, Inc. and its agents, including directors, staff, and the employees of facilities outside of the campgrounds from any and all liability.

I agree to abide by the above mentioned commitments, and releases.
I have read, understand, agree with, and have signed the Tay Valley Bible Camp Statement of Faith and the Staff Conduct Policy.

Signature__________________________Date_____________________