THE PRESBYTERY OF NEW HARMONY

CAMP PEE DEE RETREAT CENTER

1201 CAMP PEE DEE ROAD
BENNETTSVILLE, SC 29512
1-843-479-3051
COUNSELOR APPLIATION
Name_____________________________M / F Social Security #__________
Date of Birth____________E-Mail____________________________________
Address:_______________________City:______________________zip:______
School Address (if resident student)____________________________________
City________________________________________State_________zip______
Cell Phone # __________________________Home Phone #_______________
High School Grade

College 1 2 3 4

Grad School 1

School Name_______________________ City ________________________

Major _________________
Church_________________________________Pastor____________________
Youth Director___________________________Church Phone #_____________
Address of Church________________________________City______________
State____________Zip___________
What leadership roles have you had in your home church___________________

Have you ever been on a mission trip? Y / N Who was the leader and contact #
___________________________________________#_____________
What is/was your favorite thing about your church?
_______________________________________________________________
Why_____________________________________________________________
Have you ever led children/youth in activities? Y / N What__________________
What if anything makes you uncomfortable about the Church________________
________________________________________________________________
______________________________________________
Do you work now? Y / N

Where do you work________________________

Supervisors Name___________________________Contact #_______________

Please describe other jobs you have had and why did you leave___________

________________________________________________________________
Please describe volunteer experiences you have had______________________
_______________________________________________________________
On a separate sheet of paper, please answer the following questions and attach
them to your application:
What are your strengths? What are your weaknesses?
What do you think you can contribute to Camp Pee Dee this summer?
Why do you want to work at Camp Pee Dee?
Have you ever worked at a camp? Y/N Where__________________How many
Yrs._________
Were you ever a camper? Y/N Where______________________________
What are your fondest memories about you experience at camp?____________

Do you see yourself as a team leader or team follower?___________________

________________________________Why_____________________________
Do you see yourself as a Christian? Y/N

Why or Why not_________________

How do you experience Jesus Christ in your personal life___________________

Who is Jesus Christ to you and what impact does this have on your daily life?

Are you willing to share your faith story with others________________________

How_____________________________________________________________

Explain any spiritual practices you practice on a regular basis: Prayer? Y/N
Scripture reading? Y/N
Do you swim? Y/N

Daily Devotion Y/N

Others:______________

Are you certified as a lifeguard? Y / N

One more thing I would like for you to know about me:

Please list 3 references other than relatives, your minister and youth director who
can attest to your character and ability to work with children/youth. You are
responsible for giving the references forms to these people and seeing that
the forms are returned to The Summer Program Director of Camp Pee Dee
Retreat Center.
Name:__________________________________Relationship_______________
Address_________________________City_____________________State____
Zip_______Phone #___________________Email_____________________

Name_________________________________ Relationship_______________
Address_________________________City______________________State___
Zip________Phone #__________________Email________________________

Name_________________________________ Relationship_______________
Address_________________________City______________________State___
Zip________Phone #__________________Email________________________

On a separate sheet of paper, please get a recommendation from your

Minister and your Youth Director. Please have them tell Camp Pee Dee
Summer Director why they think your would be a good counselor.

Background Information
Have you ever been convicted of a felony or misdemeanor that is related to the
abuse, mistreatment, or molestation of a child or any other crime other than a
traffic violation? _____N0________Yes If yes, please provide complete
information.
Are you a licensed driver?_______No_____Yes if yes, what state__________
License Number_________________
BACKGROUND VERIFICATION DISCLOSURE
As part of the employment process and instructed by our insurance carrier, The
Presbytery of New Harmony will obtain an investigative consumer report on you.
The investigative consumer report may include information regarding your credit
worthiness, credit standing, credit capacity, character, general reputation,
personal characteristics or mode of living. The following Consumer Reporting
Agency will prepare the report:
ChoicePoint Services Inc.
1000 Alderman Dr.
Alpharetta, GA 30005
By signing this application for employment, I give The Presbytery of New
Harmony authorization to run an investigative consumer report.
Signature_________________________________________Date___________
In submitting this application, I understand that a personal interview will be
required before employment can be granted. I authorize investigation of all
statements contained in this application for employment as may be necessary in
arriving at an employment decision. I authorize all my previous employers,
schools and all other references to furnish or verify the information requested.
By my signature I hereby declare that the information provided by me in this
application is true and complete to the best of my knowledge. I understand that
any falsification or misrepresentation in this application is cause for not being
hired or termination of employment with Camp Pee Dee Retreat Center. I
understand that I answer to the Summer Director of Camp Pee Dee Retreat
Center and he/she has hiring and firing authority as set forth by the Presbytery
and the Camping Division.
_____________________________ __________________________ _______
Signature of Applicant
Signature of Parent/Guardian
Date

Staff Training Week: June 23 through June 28. This week is mandatory and you
will be paid for it.
Dates of Summer Camp: July 6 through August 9, 2013
Pay:
1st year: $175.00 per week
2nd year: $180.00 per week
3rd year: $190.00 per week
All staff will have room and board at no cost

If you have any questions please call Nancy at 334-332-6627

Please mail application to:

Summer Camp Director,
Nancy Washburn
1201 Camp Pee Dee Rd.
Bennettsville, SC