2004 Summer Camp Staff Application (page 4 of 4)
( Please send a recent photo for our file! )
In addition to this form, please make sure you also complete and submit the "STAFF RECOMMENDATION FORM"
REFERENCES
Give name, address and telephone number of three (3) references who are not related to you:

1.____________________________________________________________________________

2.____________________________________________________________________________

3.(Previous/Present Employer)_____________________________________________________

Scholarship Information—EWRS will assist as possible.
Will you be attending school the fall term following camp?  (Y/N)_____ Where? ___________________

HEALTH
Who should be contacted in case of emergency?____________________ Relationship _____________
Work phone__________________ Home phone __________________ Cell Phone _________________

Allergies________________________________  Current Medication_____________________________

Have you ever had a major illness or accident?  If so, when and explain __________________________
_____________________________________________________________________________________

Do you have any physical or mental conditions which  would affect your work at camp?
_____________________________________________________________________________________

Your present health is:    Excellent   Good   Fair   Poor   Date of last tetanus shot _________________

GENERAL INFORMATION
Why do you want to work at Ellijay Wildlife Rehabilitation  Sanctuary’s “Camp Wildlife”?
_____________________________________________________________________________________

As a camp staff member, in what way would you be willing to share Jesus with a camper? (speaking, music, drama, etc.) Please explain _______________________________________________________

Have you ever been convinced of a felony (Y/N) ___ (Conviction will not necessarily disqualify applicant from employment) If yes, please explain_______________________________________________

Have you ever been charged, disciplined, or convicted for any act of unlawful sexual conduct, child abuse, and/or child sexual abuse? (Y/N) ___ If yes, please explain _____________________________
____________________________________________________________________________________

I hereby attest by my signature that all information in this application is true to the best of my knowledge.
Signature____________________________________________ Date: ___________________________