Staff Re-Application Form
Please upload a clear, recent photo here.
(in case of employment)
Name of Parent(s) or Guardian(s)
School You Are Currently Attending
Grade Next Year
School You Plan To Attend Next Year
Other Goals For Next Year
Desired Positions At Camp
In case you are hired, please fill in the following information...
Commitments for next summer (engagements,
family plans, etc.)
I would like to take the scholarship option. Please send my earnings to school.
I would not like to take the scholarship option. Please send my earnings to my address.
Please send my earnings to this
If hired at Camp Blue
Ridge, my staff uniform
shirt size is:
Your present health is:
Describe your personal physical fitness
program (50 words or less)
Last injury or operation (50 words or less)
What allergies you have? (50 words or less)
Do you have any physical or mental conditions that would limit your work at camp?
If so, please explain (50 words or less):
Who should be contacted in case of an emergency?
Emergency contact phone number
Emergency contact alternate phone number
Conduct Clearance Information
Camp Blue Ridge understands that providing a safe environment for campers, visitors, and children is a first priority and therefore requires that the applicant provide complete disclosure as to the following questions concerning prior conduct and/or misconduct. Please answer the questions completely, providing any and all detailed information pertaining to your answers, including attaching of any reports or other documents pertaining to your answers.
Have you ever been charged, investigated, accused and/or convicted in any jurisdiction, forum, venue, or other judicial or quasi-judicial, forum of any criminal offense? Criminal history should include driving offenses greater or more serious than a speeding ticket.
If yes, please provide dates, city, and state of any such conduct or event:
Have you ever been (formally or informally) accused, charged, or disciplined for unlawful sexual conduct, any child abuse and/or other sexual abuse?
If yes, please provide a complete history of any and all events or conduct for which you have been formally or informally accused, charged, investigated, disciplined, or otherwise the subject of inquiry, scrutiny, or investigation of any unlawful conduct involving a child or underage person including (but not limited to) sexual misconduct, child abuse, child neglect, child endangerment and/or any offense in which a child or underage person was the victim or alleged victim. By this question you are to provide the date, location (city and state) and ultimate disposition (charged/not charged, convicted/acquitted, or dismissed) of such investigation:
If you have answered any of the preceding questions in the affirmative, please set forth in detail any and all reasons you believe you are the appropriate candidate for employment at Camp Blue Ridge. Include in your answer any and all rehabilitation, education, training, or other extenuating or mitigating circumstances that you believe are appropriate:
Please give the name of a non-family member who has known you for more than 5 years and can verify the above information:
Please note, this application is not complete without your signature. Read the following statement carefully.
The information contained herein and my answers to the question above are true, accurate, and complete. By my signature below, I attest and affirm to the truth, accuracy and completeness of my answers. I acknowledge that a failure to provide complete, truthful and accurate answers may lead to my termination as an employee of Camp Blue Ridge or the rejection of of my application of my application for employment. By my signature below, I hereby grant and provide permission for the Potomac Conference of Seventh-day Adventists and/or individuals, agencies, or authorities to verify the accuracy of the information contained herein and my eligibility for this job. I hereby authorize and release any and all individuals to truthfully and completely provide information to Camp Blue Ridge or the Potomac Conference of Seventh-day Adventists, pertaining to my eligibility and this application for employment with Camp Blue Ridge.
In case of my employment at Camp Blue Ridge, I give permission for pictures and/or video of me to be used in camp promotional material.
I have reviewed the above information and certify that it is correct as of today's date:
This form is complete
This form is NOT complete
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