How long at current address?
Driver's License Number
Social Security Number
Are you eligible to work in this country?
Note: If you are chosen for a paid position, you will be required to show documents verifying your employment eligibility and identity to complete the INS Form I-9 as required by the Immigration Reform and Control Act.
Please list your addresses INCLUDING college residences (if applicable) in the past three years:
Why do you want to work at TEC? What interests you about being a camp counselor?
What has prepared you for the position for which you are currently applying?
What particular gifts, interests, passions, or activities can you bring to the camp program? What could you possibly share, teach, or lead?
If you are chosen to work at TEC, what do you hope to gain from the experience?
Employment History: Current Employer
Please include the following information:
Current employer's company name, full address, your immediate supervisor's name, your immediate supervisor's phone number, the position you hold/held, dates of employment, and reason for leaving the position (if applicable)
Employment History: Past Employment
Please include the following information for at least the two jobs you held prior to your current one (if you have held less than two jobs, please indicate that below): Please include the following information:
Past employer's company name, full address, your immediate supervisor's name, your immediate supervisor's phone number, the position you hold/held, dates of employment, and reason for leaving the position (if applicable)
Please include the following information for all volunteer work you have done that deals with children or youth:
Organization name, a contact person, phone number, your duties, and the dates you worked volunteered in this position.
Please include your complete educational history for all education you have completed including and after high school: Name of school, full school address, type of school, name of program/degree, and whether you have completed the program.
Please indicate someone whom we can contact for whom you have served in a professional/civic capacity. Include the person's full name, full address, daytime phone number, how long you have known this person, and his or her relationship to you.
Please indicate someone whom we can contact who knows you very well in a personal capacity. Include the person's full name, full address, daytime phone number, how long you have known this person, and his or her relationship to you.
Have you ever been accused of physically, sexually or emotionally abusing a child or an adult?
If you answered yes to having been accused of physical, sexual, or emotional abuse of a child or adult, please explain
If you are chosen to work at Thunderhead, we will administer a full background check as required by safe church policies. Is there anything we should be aware of that might come up in your background check?
Things that you should report are not limited to felony convictions, but also include misdemeanors, arrests, outstanding warrants, traffic violations and tickets, citations, charges that have not yet gone to trial, etc.
If you answered yes to there being anything that may come up in your background check, please explain here.
Sign below to signify your agreement to comply with this statement.
I agree to do my best to prevent abuse and neglect among children and youth involved in church
activities and services.
I agree not to physically, sexually or emotionally abuse or neglect a child or youth.
I agree to comply with the policies for GENERAL CONDUCT FOR THE PROTECTION OF CHILDREN AND YOUTH defined in the Policies for the Protection of Children and Youth from Abuse.
I agree to comply with the GUIDELINES FOR APPROPRIATE AFFECTION with children and youth.
In the event that I observe any inappropriate behaviors or possible policy violations with children or youth, I agree to immediately report my observations.
I acknowledge my obligation and responsibility to protect children and youth and agree to report known or suspected abuse of children or youth to appropriate church leaders and state authorities in accordance with the POLICIES FOR THE PROTECTION OF CHILDREN AND YOUTH FROM ABUSE.
I understand that the church will not tolerate abuse of children and youth and I agree to comply in spirit and in action with this position.
Acknowledgment, Release and Signature Form
To the best of my knowledge, the information contained in this application is complete and accurate.
I understand that providing false information is grounds for not hiring me or choosing me for a volunteer position or for my discharge if I have already been hired or chosen.
I authorize any person or organization, whether or not identified in this application, to provide any information concerning my previous employment, education, credit history, driving record, criminal conviction record, sexual offender registry or other qualifications for my employment or volunteering. I also authorize Thunderhead Episcopal Center to request and receive such information.
If hired or chosen, I agree to be bound by The Diocese of South Dakota’s policies and procedures, including but not limited to its POLICIES FOR THE PROTECTION OF CHILDREN AND YOUTH FROM ABUSE and CODE OF CONDUCT FOR THE PROTECTION OF CHILDREN AND YOUTH. I understand that these may be changed, withdrawn, added to or interpreted at any time at the sole discretion of the diocese and without prior notice to me.
I also understand that my employment or volunteering may be terminated, or any offer or acceptance of employment or volunteering withdrawn, at any time, with or without cause, and with or without prior notice at the option of the Diocese or myself.
Nothing contained in this application or in any pre-employment or pre-volunteering communication is intended to or creates a contract between myself and Thunderhead Episcopal Center for either employment, volunteering or the providing of any benefit.
Thank you for submitting your application to work as a counselor at TEC for the 2017 camping season. We will be in touch with you with more information in a few weeks. If you have any further questions or need to clarify any information you submitted, please contact the
Rev. Portia Corbin.