Staff Application



Application Form must be received by March 1, 2013
First Name
Middle Initial
Last Name
Email Address
Home Phone
Cell Phone
Birth Date
What size T-Shirt do you wear?
T-Shirt Size
Church Attended
Church Address
Church Phone Number
Pastor's Name
In what ways are you involved in the worship and/or ministry of your church, or explain your involvement in any church related and religious activities?
Please explain in one sentence why you want to serve at Camp Luther.
What would be the greatest strength that you would share with Camp Luther?
In what capacity would you like to serve?
If you selected "Teacher" above, please select the teaching areas in which you are qualified to serve.
In which program would you like to serve?
First Choice
Second Choice
Third Choice
Are you certified in First Aid?
Have you taken the training for “Safe Guarding God’s Children”?
If Yes, where and when?
Please send the Camp Director a copy of your certificate if you know we don't already have it.
If you are new to the Camp Luther staff, please list three references. Please ask your references for permission to use their names. At least one reference should be a member of your church. Letters from all references will be required for new applicants. Send them with you application or, if you are submitting online, as soon as possible.
Reference 1 (Name, Address, Phone Number)
Reference 2 (Name, Address, Phone Number)
Reference 3 (Name, Address, Phone Number)
Have you ever been discharged or forced to resign from employment or a volunteer role?
If yes, please give the details, including the name of the employer or group.
Have you ever been convicted of a crime or are you under charges for any offense against the law, other than minor traffic violations?
If yes, please give the details.
CERTIFICATION (Please read this statement carefully before signing!) I hereby certify that my answers to the above questions are true, complete, and correct. I understand that false answers on this application may be grounds for immediate dismissal from Camp Luther. I also understand that the above answers are subject to verification.
Electronic Signature - by completing the section below, you certify that the information on this form is true, complete, and correct.
Full Name
Date (dd/mm/yyyy)
Required letters and certificates may be mailed to: Camp Luther Director, c/o St. Mark’s Lutheran Church, Rt. 1, Box 210, Clarksburg, WV 26301