Applying For:	COUNSELOR	YAP	UNDECIDED

Last Name:

First Name:

Middle Name:

Please attach a recent photo of yourself. It is not required but does help us identify you especially if you have

ever been a camper here or a member of the Summer Technician or Engineer Program.

H	Street Address	Home Phone # (000-000-0000)

O

M	City	State	Zip	Cell Phone # (000-000-0000)

E	Email address	Blog/Facebook or Other address:

Gender:	Marital Status

Male	Female	Single Engaged Married Separated Divorced

D	Date Available to Start?	(mm/dd/yyyy)	Expected Ending Date?	(mm/dd/yyyy)
A

T

E	Please list any dates that you need to be gone.

S	Total Number of Weeks Available?	See our Camp Calendar at www.CampBarakel.org for help on our summer schedule!

C

H	Home Church	Pastor’s Name

U

R	Office Street Address	Pastor’s Office Phone (000-000-0000)

C

H	City	State	Zip	Church or Pastor’s Email

High School	Date of Graduation (mm/yyyy)

E

D	Current College	Number of years	Date of Graduation (mm/yyyy)

U

C	Your address at College	Phone where you can be reached (000-000-0000)

A

T	School City	State	Zip	School Email

I

O	If you are currently in college, on what date do you intend to return home?	Major(s)?

(mm/dd/yyyy)
N	College (Previous?)	Number of years	Date of Graduation (mm/yyyy)

Degree Earned?	Other Certifications?

P

O

S

I

T

I

O	YAPS Please list by Preference the Positions that you are most interested in:

1 –

2 –

3 –

YAP Positions:

Archery Instructor

Cooks Assistant

Handcrafts Leader

Laundry Coordinator

Lifeguard

Mountain Bike Instructor

Piano Player

Riflery Instructor

Trading Post Leader
N

S

/	In addition to the above information, please list all certificates that you hold, current or expired (eg. Lifeguard, CPR, AED, Boy or Girl Scouts, National Rifle Association, etc). Designate with a “C” for current or “E” for expired.

1 -	2 -

3 -	4 -
E

X

P	Please also list other licenses, talents, musical abilities or experiences:

1 -	2 -

3 -	4 -
E

R

I

E	Camping Experience:

As a camper – where?	Number of years

1 -

2 -
N

C

E	Are you a former Barakel Technician, Engineer or staff member from another camp?

Where?	Position held?	Number of years

1 -

2 -

3 -

In an effort to comply with mandates issued for all camps by the Michigan Bureau of Regulatory Services, we ask for your cooperation in giving us the following information (see “Certification” paragraph at the end of the application form):

Date of Birth (mm/dd/yyyy)	Drivers License Number	State Issued (Driver’s License)

L

E

G

A

L

Have you ever been convicted of any offense other than minor traffic violations? Yes No

Have you ever been convicted of (or are you the subject of pending charges for) any offense involving actual or attempted child abuse or sexual molestation in any state or country? Yes No

If yes to either of the above questions, please provide details (including dates and how it was resolved, etc.) See Additional Space Section.
If you are offered a position, and if you intend to receive money from camp’s educational assistance fund, will you be able to verify that you are legally permitted to work in the United States, either by proving U.S. citizenship (or permanent residence status) or with un-expired INS employment authorization? Yes No
To prove US Citizenship, you will need to show: (upon acceptance bring these with you to camp)

Your original social security card, or a certified copy of a birth certificate, or a working visa

And

Another form of identification such as a driver’s license, school photo I.D. card, valid US passport, or voter registration card.

H

E

A	Do you have any physical, mental or medical impairment or disability that would limit your performance in the position for which you are applying? Yes No If yes, please explain:

L

T

H	Are you currently under psychiatric care or counseling, or taking prescription drugs for similar ailments?

Yes No If yes, please explain:

E

M

P

L

O

Y

M

E

N

T

H

I

S

T

O

R

Y

Employment Experience:

Please list your last three jobs (if possible) beginning with your present (or last) job. Include military service assignments and volunteer activities. It is important that you fill in this section as completely as possible.

Employer	Supervisor

Address	City	State	Zip	Phone (000-000-0000)

Job Title	Reason for Leaving	Employed from: (mm/dd/yyyy)

Work Performed	Employed to: (mm/dd/yyyy)

Employer	Supervisor

Address	City	State	Zip	Phone (000-000-0000)

Job Title	Reason for Leaving	Employed from: (mm/dd/yyyy)

Work Performed	Employed to: (mm/dd/yyyy)

Employer	Supervisor

Address	City	State	Zip	Phone (000-000-0000)

Job Title	Reason for Leaving	Employed from: (mm/dd/yyyy)

Work Performed	Employed to: (mm/dd/yyyy)

E

S

S

A

Y

S

/

I

N

T

E

R

V

I

E

W	IMPORTANT! Please answer the following and attach or send in later. These are important issues; especially as they relate to the position you seek here at Barakel. Please give them careful consideration and take the time to answer them completely. If you have been a Counselor or YAP previously at Barakel, you need only answer numbers 1 and 4.

Please tell us why you desire to serve at Barakel this summer.

Please describe your salvation experience.

Please tell us why (with scriptural support) you believe your salvation is permanent.

Describe events or situations (within the last year) that lead you to believe that you are a growing Christian.

List three positive attributes that you believe you possess. Explain why you think they would apply in a camp setting.

(YAPS ONLY) Please explain your choice of YAP positions as you have listed them in this application and any experience that you may have.

Remember to write your name on the essays.

INTERVIEW:

The other component of the application process is an interview. Our preference is that this can be done at Barakel however; we realize that may not work in every situation. Sometimes we are in your area or a meeting spot can be arranged. A phone interview is also possible but is a last choice. When we have received your application we will contact you about possible interview time and opportunities.

R

E

F

E

R

E

N

C

E

S	Character References:

Please have four character references sent to Camp using the Camp Barakel Character Reference Forms. Select adults (but not relatives) to fill out these forms. Preferably one form should come from your Pastor, Youth Pastor, or another church leader. Please have your reference person send the completed reference to us. This can be done via email or the postal system. The reference form is available on our website at www.CampBarakel.org/forms.asp
1) Name	Relationship

2) Name	Relationship

3) Name	Relationship

4) Name	Relationship

This section is included as room for more explanation or for comments or questions?

C

E

R

T

I

F

I

C	“I recognize that Camp Barakel is relying on the accuracy of the information I have provided in this application form. Accordingly, I attest and affirm that the information I have provided is absolutely true and correct. I understand that the completion and/or execution of this application does not insure me a volunteer position, nor does it obligate me or the organization in any way. I fully understand that the omission and/or misrepresentation of facts requested may be cause for immediate dismissal without prior notice. I am willing to submit to a physical examination if requested by the organization. I authorize the organization to contact any person or entity listed on this form, and I further authorize any such person or entity to provide the organization with information, opinions, and impressions relating to my background or qualifications. I voluntarily release the organization and any such person or entity listed on this form from liability involving the communication of information relating to my background or qualifications. I further authorize Camp Barakel to conduct a criminal background investigation if such a check is deemed necessary. I have read, understand and agree to the above.”

Please type your name in the box as your signature!
A

T

I	Applicant’s Signature:	Date

(mm/dd/yyyy)
O

N	Parent or Guardian Signature (if applicant is a minor):	Date

(mm/dd/yyyy)

READY TO SEND THIS APPLICATION TO CAMP?

First, save this application! Then attach the saved file to one of the emails listed below. You can attach your essays or include them in the email. You may also print and mail this application to us. Please use the address listed on the front page of this application. We will contact you when we have received your application.

Applying for Counselor or are Undecided - Send to Dave Douglas	Applying for YAP Position - Send to Jon Ford

DaveD@CampBarakel.org	JonF@CampBarakel.org

12/16/2008

Camp’s use:

Rcvd. ___/___/____	RCCR

Rspd. ___/___/____ Intrv. __/___/___	4 / Ch. _____

A./R. __/___/___
Camp’s use:

Ref.

1 __________

2 __________

3 __________

4 / Ch. ______

Summer Staff Volunteer

Application Form

Camp Barakel

Camp Barakel; Fairview, MI 48621-0159; Phone (989) 848-2279

www.CampBarakel.org

Thank you for your application. We trust that the Lord has led you in your desire to be a part of the Barakel summer staff. It is a big responsibility! We will get final word to you just as soon as we have reviewed your application and received all your references. As a reminder – check to see that you have given all required information. A recent photograph is not required, but it is appreciated. Thank You!

Jon Ford

2008-11-26

Camp Barakel Program