Pleasant Hill Home

Contact
General Information
info@phoc.org


Director
director@phoc.org

4654 Pleasant Hill Rd.
Perrysville, OH 44864
419 938-3715

Summer Staff Application
Please complete each section. Incomplete application cannot be considered.
PERSONAL INFORMATION Please complete.
Last Name First Name MI
Home Address City State Zip
Home Phone () Cell Phone ()
E-Mail Address
Male Female
Qualified applicants must be at least 18 years of age and have graduated high school. Do you meet this requirement? Yes No
PLEASE CHECK THE POSITION(S) YOU ARE APPLYING FOR
June 5 - August 4, 08 Counselor Cook Program Coordinator
Lifeguard Nurse Maintenance Staff
EDUCATIONAL BACKGROUND Please complete.
High School Graduation Date
College Graduation Date
As of September 2008 I will be in: College Highschool
As of September 2008 I will be a: Sophmore Junior
I will not be enrolled in school this fall Freshman Senior
Please list any awards, activites or events you are or have been involved with in school:
EMPLOYMENT BACKGROUND Please list your last two places of employment
Place of employment From Date to
Supervisor's Name Phone ()
Position and responsibilities
Place of employment From to
Supervisor's Name Phone ()
Position and responsibilities
REFERENCES Please list three references. Do not use family members. At least one should be a current or former employer and at least one should be a teacher or pastor. You will need to direct the three persons listed here to visit the refenence page to fill out a short online reference form. Final decisions cannot be made untill these online forms are submitted. If your references are not able to complete the online form you may give them a printed version which can be found on our staff page.
1. Full Name Relationship to applicant
Phone ( )
2. Full Name Relationship to applicant
Phone ()
3. Full Name Relationship to applicant
Phone ( )
IMPORTANT INFORMATION Please complete.
Where do you currently attend church?
In what ways if any are you involved?
I do not attend church.
Please give us your personal testimony. Include when and how you became a Christian and any important experiences in yourChristian Life so far:
If a camper expressed interest in becomming a Christian, how would you help them?
Have you ever been convicted of a crime, other than a minor traffic offense? Yes No
Have you ever been convicted of any type of sex abuse offense? Yes No
Do you hold current certification in the following? CPR WSI
First Aid Lifeguard
Do you have any special skills or certifications that would be helpful in the summer camp enviornment? Please include any previous employment in or summer camp experience. Please list:
READ CAREFULLY THEN CHECK AND SIGN ACCORDINGLY.
I understand that if offered a position at the Pleasant Hill Outdoor Center, I will be committing myself to a summer of service, and that my behavior and attitude will be examined in terms of my example and ministry to others.
I understand that untrue, misleading, or omitted information herein or in other documents completed by the applicant may result in dismissal, regardless of the time of discovery by the camp and...
I certify that (a) no civil, criminal, ecclesiastical complaint has ever been sustained or is pending against me for sexual misconduct, or (b) I have never been required to receive professional treatment for reasons related to sexual misconduct on my part and...
I hereby authorize Pleasant Hill Outdoor Center to run a criminal background check at its discretion and understand that information obtained will be used to determine employment eligibility and...
I certify that I am representing only myself in this application and that this has been completed by the person whose name is listed on the application and entered below.
Please sign your name here: Date:
Thank you again for your interest. If you have any questions about your application please contact us at 419 938-3715. We will be actively reviewing applications as we receive them and begin interviews by January 1, 2008. God bless as you prepare for His service this summer! We'll be in touch.
Double check that you have completed all sections and then press submit. Remember, you'll need to direct your three listed references to the references page (link on Employment page) to complete a short reference form. You may also print a paper reference form from the staff information page. Final decisions cannot be made on applications untill references have been completed.
Is there anything else you want us to know?
4654 Pleasant Hill Rd
Perrysville, OH 44864
(419) 938-3715