Employment/Volunteer Application

First Name Last Name Middle Initial
Street Address City State Zip Code Telephone
Email Address

Position applying for

Have you ever worked at family camp before? Yes No If yes, when?

Do you have any friends or family working at family camp? Yes No
If yes, Name Relationship

If hired, would you have reliable transportation to and from camp? Yes No

Are you at least 18 years old? (If under18, hire is subject to verification that you are of minimum legal age.) Yes No

Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodations?
Yes No If no, describe the functions that can not be performed:

(Note: We comply with ADA and consider reasonable accommodation measures that may be necassary for eligible applicants/employees to perform essential functions. Hire may be subject to passing a medical examination, skill and/or agility test.)

Have you ever been convicted of a criminal offense (felony or serious misdemeanor)? (Convictions for marijuana related offenses that are more then 2 years old need not be listed.) Yes No If yes, state nature of crime(s), when and where convicted, and disposition of the case:

(Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, date of the offense, the surrounding circumstances and the relevance of the offense to the position(s) applied for may, however, be considered.)

Education, Training and Experience
High School
School Name City State Years Completed Did you Graduate? Yes No
Secondary Schooling
School Name City State Years Completed Did you Graduate? Yes No

Business References
List below three persons not related to you who have knowledge of your work performance within the last 3 years.
Name Occupation Telephone Relationship
Name Occupation Telephone Relationship
Name Occupation Telephone Relationship

Employment History
Employer Address Telephone
Job Title Contact Name From Date To Date
Work Performed Reason For Leaving
May we contact employer for a reference? Yes No

Employer Address Telephone
Job Title Contact Name From Date To Date
Work Performed Reason For Leaving
May we contact employer for a reference? Yes No

Employer Address Telephone
Job Title Contact Name From Date To Date
Work Performed Reason For Leaving
May we contact employer for a reference? Yes No

Due to the nature of this position Silver Lake Campers Association may require a background check to be performed on staff and volunteers.
Will you submit to a background check? Yes No

Please Read Carefully, Check Each Paragraph and Select Submit

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.
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I hereby authorize the organization to thoroughly investigate my references, work records, education and other matters related to my suitability for employment, and I further authorize the references I have listed to disclose to the organization any and all letters, reports and other information related to my work records, without giving me prior notice to such disclosure. In addition, I hereby release the organization, my former employers and all other persons, corporations, partnerships and associates from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.
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I understand that nothing contained in the application, or conveyed during any interview which may be granted or during my employment, if hired, is intended to create an employment contract between me and the organization. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period, and may be terminated at any time, with or without prior notice, at the option of either myself or the organization, and that no promises or representations contrary to the foregoing are binding on the organization unless made in writing and signed by me and the organization's designated representative.
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