Form

Crossways Summer Staff Application 2012
IMPORTANT!!! Before you start, please review this Application form and complete the Essay Questions in a Word document. You will be asked to upload your Essay Questions at the end of this form. Please have your document ready before you start the form. You won't have an opportunity to save this form once you start.
Full Name*
First Name Last Name
Gender*

Male Female
Contact Information
Please let us know how to communicate with you. Leave blank if not applicable. Please don't include mailing addresses you can't receive mail at (exe future school address.)
School E-Mail
Permanent E-Mail (not school)
Cell Phone
Permanent Phone
School Phone
Preferred method of contact

School E-Mail Permanent E-Mail Cell Phone Permanent Phone School Phone
Permanent Address
City
State
Zip Code
Will you be at least 18 years old by June 1, 2012?

Yes No
Will you be at least 21 years old by June 1, 2012?

Yes No
List the positions you are applying for in order of preference.
Position Preference #1
Position Preference #2
Position Preference #3
Please rank site preference with #1 as your first choice.
Site Preference #1
Site Preference #2
Site Preference #3
Site Preference #4
Education Background
You will receive a copy of your submission at the above email address.
College/University
City, State
Major or academic interest
School Address
City
State
Zip
Date you will no longer be at this address
/ Month / Day Year
Present Class Level
Graduation Year
Other School (High School, College, Technical College) you have attended, degree and Years attended.
Church Membership
Crossways is associated with the Evangelical Lutheran Church in America (ELCA), however, our programs serve children and youth from many denominations. It is not necessary for our staff to be Lutheran, however, all must be Christian and should be comfortable in a Christian camping environment.
Home Congregation, City, State
Denomination
Pastor(s)
Campus Ministry Organization
Campus Ministry Pastor/Leader
Camp Skills and Interests
For each of the following, indicate your skill or interest.

1 – Strong experience and leadership skills
2 – Some experience, could provide leadership assistance
3 – Minimal experience, interested in learning
4 – Not comfortable in this activity, no interest/experience
Canoeing
Storytelling
Dance
Biking
Challenge Course
Clowning
Rock Climbing
Group Games
Vocal Music
Worship
Fishing
Outdoor Cooking
Tent Camping
Drama & Skits
Backpacking
Public Speaking
Arts & Crafts
Puppetry
Song Leading
Sign Language
Nature Activities
Video Production
Musical Instruments (list instruments & skill level)
Sports (list sports & skill level)
Arts (list media & skill level)
Other
Certifications
Please list expiration dates of certifications you hold.

Examples are Standard/Advanced First Aid, CPR, Lifeguard, First Responder, Advanced Life Saving, EMT, LPN, RN, Water Safety Instructor, CDL.
Certification and Expiration Date
If planning on taking a course for certification, please list details including anticipated completion date.
Camp History
Have you ever been a camper

Yes No
List Camp Name(s), location, years attended
Have you ever been a member of a camp staff?

Yes No
List Camp Name(s), location, years served
Employment History
Please list past paid & volunteer positions with most recent position first.
1 - Employer
Position
Supervisor
Phone Number
Dates of Employment
2 - Employer
Position
Supervisor
Phone Number
Dates of Employment
3 - Employer
Position
Supervisor
Phone Number
Dates of Employment
Background Information
Have you ever been convicted of a felony?

Yes No
If yes, explain.
In the past three years have you had any traffic violations, tickets or other driving related incidents?

Yes No
If yes, explain
Type your initials here to certify that this information is correct.*
References
Give name, address, telephone number, and relationship of two references who have witnessed your character and/or job performance. Please do not list relatives, friends, or roommates. Make sure to give a reference form to the individuals you list below.
1 - Name of Reference
Relationship to you
Phone Number
2 - Name of Reference
Relationship to you
Phone Number
Essay Questions
Please upload the Essay Question Word document here. If you have difficulties uploading your file, you may also email us your essay questions at kenzie@crosswayscamps.org . Thanks!
Upload file
Enter an email in the space below to receive a copy of this application via email.
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Crossways Summer Staff Application 2012

Contact Information

Education Background

Church Membership

Camp Skills and Interests

Certifications

Camp History

Employment History

Background Information

References

Essay Questions