Rockfish
Camp & Retreat Center
Staff Application
226 Camp Rockfish Road
Parkton, NC 28371
Phone: (910) 425-3529
Fax: (910) 875-6177
*denotes required field
*First Name
*Last Name
* Email Address:
Are you a returning Rockfish staff member?
Yes
No
If Yes, what title/position did you hold and what activities did you lead or assist with?:
Title/Position:
Activities:
Current Address:
Dates of this address:
*Address
*City
*State
*Zip
*Telephone
Permanent/Home Address:
Same as above
Address
City
State
Zip
Telephone
Other Information:
Age as of June 1:
Date of Birth (MM/DD/YYYY):
Male
Female
Social Security Number:
Driver's License Number:
State issued:
Do you have any violations?
Yes
No
If yes, please explain:
Do you have a current commercial drivers license? State:
Do you have any dietary restrication?
Yes
No If yes, please describe:
Please note that Rockfish DOES NOT provide special meals for vegetarians.
Do you have any physical limitations which might limit your activity and/or participation while at camp?
Yes
No
If yes, please describe:
Do you have any allergies, or do you require any special medical treatment or attention while at camp?
Yes
No
If yes, please describe:
Have you ever been convicted of a crime?
Yes
No
If yes, please explain (voluntary):
Will you be keeping a private vehicle at the camp during your stay?
Yes
No
Staff bringing private vehicles must keep them parked in the designated staff parking area and use them only according to camp policies.
I give permission for Rockfish to request copies of personal records from my school, employer, and/or any other source which are necessary to properly conduct a background check.
What dates are you available for employment at camp? (Normal arrival date is May 19, departure on August 9) From
to
Are you interested in staying for the newly added week of camp (departure date from camp would be August 16)?
Yes
No
Staff who are available for the full ten or eleven weeks are considered for employment first. Very few staff will be considered that are available less than this length of time.
Previous camp experience:
I have never worked at a camp.
I have worked at a camp. How many years?
Most recent camp: Dates of employment From
to
Position/Title
Name of camp
Name of Camp Director
Camp Address
Camp Telephone
I have never been a camper.
I have been a camper. How many years?
School and Employment Information:
Currently a college student. Name of College
Major or Field of Study
Indicate level completed as of this Spring :
Freshman
Sophomore
Junior
Senior
Graduate Student
Graduating High School this year
Professional/Currently Employed
Date employment began:
Position/Title
Employer Company Name
Employer Contact Person
Employer Address
Employer Telephone
I currently hold a teaching certificate. State of issue:
Year of issue:
Number of years teaching:
Previous Employment:
Dates of Employment
Position/Title
Employer Company Name
Employer Contact Person
Employer Address
Employer Telephone
Camp Activities
Please check all activities you are qualified (with experience or certification) to lead:
List any other activities you can teach and describe qualifications:
1.
2.
3.
Please check all activities you can assist with:
List other activities you can assist with and describe qualifications:
1.
2.
3.
Please check all certifications you currently hold:
ARC=American Red Cross ACA=American Canoeing Association BSA=Boy Scouts of America
Please list any other certifications you hold:
Fully detail your experience in the TOP THREE areas you have selected.
We cannot properly evaluate your expertise without confirmation of your experience and qualifications.
Skill Area #1:
Skill Area #2:
Skill Area #3:
Why do you want to be a Camp Counselor?
Describe your relationship to Christ and the process through which it has grown.
Please include situations, events, habits, people, which have nurtured your Christian faith.
List your strengths and weaknesses. In what areas do you feel you need to grow?.
What church/Christian groups have you been actively involved in?
Describe your experience with children (i.e. youth clubs, community programs, plays, babysitting, scouting, etc.).
What ages do you feel you are best suited for working with? (This helps us place you in the appropriate age cabin, please check all that apply.)
All ages
6-8 years
9-10 years
11-12 years
13-14 years
15-17 years
Consider this: "Being a camp counselor is hard work, low paying, 24 hours a day with little time-off and almost no privacy." What are your comments and thoughts with regard to this statement?
References:
Please supply three references below. One may be a family member, the other two need to be teachers or employer.
1. Full Name
Relationship to applicant
Contact information:
Street Address
City
State
Zip
Contact Phone
Contact Email
2.Full Name
Relationship to applicant
Contact information:
Street Address
City
State
Zip
Contact Phone
Contact Email
3.Full Name
Relationship to applicant
Contact information:
Street Address
City
State
Zip
Contact Phone
Contact Email
Church Name/Location/Pastors Name:
Have you had any criminal convictions for child abuse or sex related
crimes?
Yes
No
Our Camps are in outdoor settings. Staff are required to traverse
independently and are entrusted with the care of a group of children
whose health and welfare are your prime responsibility.
Optional: Complete a one page biographical sketch, including
specialized training in camping, and experience in other fields which
might have a bearing on the position(s) for which you are applying.
The above information is true and correct to the best of my knowledge.
I authorize the camp to contact anyone regarding my experiences or background
and release from harm or liability any statements made by such persons.
Signature:
Date:
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