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CEDAR VALLEY VIEWPOINT SUMMER STAFF APPLICATIONFORM

NAME: ____________________________________________ PHONE: _______________________ PRESENT ADDRESS: _____________________________________________________________________ CITY: ______________________ ____________ STATE: __________ ZIP CODE: __________ CHURCH: _____________________________________________________________________________ CHURCH ADDRESS: _____________________________________________________________________ CITY: __________________________________ STATE: __________ ZIPCODE:___________ PASTORS NAME:_________________________________ CHURCHPHONE:___________________ REFERENCES: (MUST INCLUDE ONE PREVIOUS EMPLOYER.)1.NAME: ____________________________________________ PHONE:____________________ COMPLETEADDRESS:_____________________________________________________________ HOW LONGKNOWN:_____________________________________________________________ 2.NAME: ____________________________________________ PHONE:____________________ COMPLETEADDRESS:_____________________________________________________________ HOW LONGKNOWN:_____________________________________________________________

3.NAME: ____________________________________________ PHONE:____________________ COMPLETEADDRESS:_____________________________________________________________ HOW LONGKNOWN:_____________________________________________________________ DO YOU FIND IT EASIER TO: TEACH GAMES/RUN PROGRAMS OR RUN WORKSITE OPERATIONSHAVE YOU EVER BEEN TO CVV, CAMP ROCK OR AN EQUIVALENT WORK CAMP? YES OR NOIF YES, PLEASE STATE NAME OF THE CAMP AND YEARSATTENDED:_______________________________ _____________________________________________________________________________________ DO YOU HAVE OTHER CAMP COUNSELING EXPERIENCE? YESOR NOIF YES, PLEASE STATE CAMP NAME, POSITION HELD, AND YEAREMPLOYED:________________________ _____________________________________________________________________________________ DO YOU HAVE ANY CONFLICTS WITH THE TENTATIVE SCHEDULE AS GIVEN? YES OR NOIF YES, PLEASEEXPLAIN:_________________________________________________________________ DO YOU HAVE A VEHICLE AVAILABLE FOR USE DURING THE WEEKS YOU WOULD BEEMPLOYED: YES OR NO (PLAN TO HAVE A CLEAR SCHEDULE JUNE28

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, AND JULY 5

-10

!)PLEASE ANSWER THE FOLLOWING QUESTIONS THOROUGHLY ON ANOTHER SHEETOF PAPER!