Applicant's Name *

First Name

Last Name

Position Preference: *

Please check the position(s) you are interested in. Please be sure to read position descriptions on the Staff Information Sheet.

Activities Assistant

Assistant Nurse

Counselor

Housekeeping

Support Staff

If necessary, are you willing to serve in ANY position for which you are qualified, even if it is not checked above? *

YES

NO

Staff Orientation Availability *

Please see the "LOCATIONS AND DATES" section of the Staff Information Sheet. Compare the Handi*Camp dates to any commitments already on your personal calendar before filling out the sections below. This information is helpful to us as we consider all of our applicants and it in no way obligates the Handi*Camp organization or you. Orientation is required for ALL staff members (new or veteran) serving at Handi*Camp. Orientation is crucial to understanding the overall program and in learning the best and safest way to care for our campers. If you are unable to attend all of Orientation, please explain, and we will address each case individually.

I would like to attend Orientation March 1 - 3, 2024. I will make my own housing accomodations.

I would like to attend Orientation May 31 - June 2, 2024.

OTHER (See my comments below.)

Please check which week(s) you are interested in serving: *

June 3 - 5: Challengers - Session 1

June 6 - 8: Challengers - Session 2

June 10 - 12: Challengers - Session 3

June 17 - 19: Explorer Gals

June 20 - 22: Explorer Guys

June 24 - 26: Voyagers

July 1 - 3: Adventurers

July 4 - 6: Seekers & Discoverers

July 8 - 10: Conquerors & YABC

REFERENCE 1 - Name of Pastor, Youth Pastor or Church Leader: *

First Name

Last Name

Reference 1 - Mailing Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference 1 - Home/Cell Phone:

(###)

###

####

Reference 1 - Work Phone:

(###)

###

####

REFERENCE 2 - Name:

First Name

Last Name

Reference 2 - Mailing Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference 2 - Home/Cell Phone:

(###)

###

####

Reference 2 - Work Phone:

(###)

###

####

REFERENCE 3 - Name:

First Name

Last Name

Reference 3 - Mailing Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference 3 - Home/Cell Phone:

(###)

###

####

Reference 3 - Work Phone:

(###)

###

####

REFERENCE 4 - Name of Employer:

First Name

Last Name

Reference 4 - Mailing Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Reference 4 - Home/Cell Phone:

(###)

###

####

Reference 4 - Work Phone:

(###)

###

####

Date of hire:

MM

DD

YYYY

Employment end date: (if applicable)

MM

DD

YYYY