Summer Staff Application Name* First Last Cell Phone*Email* Best way to reach you?*Cell PhoneEmailBirthdate* MM slash DD slash YYYY Current occupation/school* School major Projected graduation date* MM slash DD slash YYYY Last day of school this spring* MM slash DD slash YYYY First day of school this fall* MM slash DD slash YYYY Home/permanent address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please specify any family, school, wedding or other related commitments that would cause you to miss any working days?(We will consider accommodating these, but there is no guarantee.)Any health concerns/allergies?Will you need a host family (housing) this summer*YesNoDo you have a driver's license?*YesNoHas your driver's license ever been suspended?*YesNoNumber of car accidents you've been involved in*Number of moving violations you've received*Will you have a car this summer?*YesNoNumber of seats (including driver)Campus ministry you're involved in* Church you attend* Length of time you have attended the church* Denomination of the church Home church (if different) Length of time you have attended your home church Denomination of your home church ReferencesName of Peer Reference*A peer reference is someone in your life who can speak about your faith and character First Last Phone of Peer Reference*Email of Peer Reference* Name of ministry reference*A ministry reference is someone in a position of authority (campus minister, pastor) who can speak about your faith & walk with the Lord as well as your participation in your church First Last Phone of ministry reference*Email of ministry reference* Ministry InformationPlease indicate your level of interest in serving in the middle school ministry:* Very Intrested Somewhat interested Not Intrested Please indicate your level of interest in serving in the high school ministry:* Very Intrested Somewhat interested Not Intrested Please indicate your level of interest in serving in the college school ministry:* Very Intrested Somewhat interested Not Intrested Self-AssessmentPlease rate yourself on a scale of 1-5, with (1) being the worst, and (5) being the bestTaking initiative*(Seeking out opportunities to serve, even when others are not) 1 2 3 4 5 Working with a team*(Being able to listen to other opinions and making compromises) 1 2 3 4 5 Admitting mistakes* (Honestly and humbly approaching others when needed) 1 2 3 4 5 Share three of your greatest strengths and two areas you could improve on*Personal Faith and ExperienceHow would you describe the gospel to a non-Christian friend?*Briefly share your testimony of how you came to faith in Jesus Christ*Describe your devotional life*Prior work experience/youth experience*Why do you want to be on summer staff?*Experience & AbilitiesPlease rate your ability to do the following on a scale of 1 - 5, with (1) being the worst, (5) being the best.Discipling others* 1 2 3 4 5 Leading a Bible study.* 1 2 3 4 5 Upfront leadership*(leading large groups of people) 1 2 3 4 5 Biblical knowledge* 1 2 3 4 5 Teaching* 1 2 3 4 5 Leading Worship* 1 2 3 4 5 Summer Staff AgreementI understand the importance of listening to and respecting authority*YesNoI will drive safely and obey all traffic laws while on summer staff*YesNoI will be on time and prepared for all meetings, events, and other summer staff commitments*YesNoMy vacation time (unless approved) will be before and/or after my summer staff commitment*YesNoAll medical, dental, and other appointments will be scheduled for a day off*YesNoElectronic signature and agreementYour full name typed below is your electronic signature and indicates that you have completed this application to the best of your ability, answered honestly and truthfully, and have read and agree to the content outlined above. In typing your name below you also affirm the seven essentials of the faith as put forth by the Evangelical Presbyterian Church (EPC). This document can be found at epc.org/about/beliefs/. If any information from your application changes, you agree to contact Fourth Church and provide any/all updates.Please type your full name as your signature and agreement, per above*
