Application Package
Dear Applicant:
High Peak Camp is a Christian camp. Our summer staff is made up of committed Christians who love kids and
being outdoors. Our camping programs can only be as good as our staff; therefore, we focus on selecting the
best staff possible. Because of the high expectations placed on our summer ministry team, we try to select
staff members who are dedicated to Christ, not only in camp, but also in their everyday lives.
Your packet should include:
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Application Instructions
Staff Requirements
Student Leadership Program Overview
Program Agreement
Application Form
Statement of Applicant for Employment Involving Work With Children
Health Insurance Form
Minor Transportation Waiver
Minor Video and Photo Waiver
Parental Disclosure Form - for Minor
1 Pastor Reference Form
2 General Reference Forms
To be considered for a position, we will need to have all paperwork completed and returned ASAP.
If you have any questions, or need any additional help, please contact
Major Vicki Gilden @ (303) 866-9295 or im.youth@usw.salvationarmy.org.
Blessings,
Major Mark Gilden
Divisional Youth & Candidates’ Secretary
Intermountain Division
1
HIGH PEAK CAMP’S MISSION STATEMENT
High Peak Camp and Conference Center is a Christian facility owned and operated by The Salvation Army, an
evangelical branch of the Christian Church. The ultimate goal of all programs is to bring people back into a
relationship with God. Our mission is to use the elements of nature and the great outdoors as a setting to
share the Gospel of Jesus Christ.
APPLICATION INSTRUCTIONS
IMPORTANT: Completed application and three reference forms must be returned to Intermountain Youth
Department by May 30th. Applications received after this date will be considered on a secondary basis, unless
we are still filling positions. Incomplete applications will not be processed. Call with any questions.
1. You will need approximately 30 minutes to an hour to complete S.A.L.T application. There are some
essay type questions that may require some additional thought.
2. Please read the entire application booklet before completing and submitting your application. This
booklet contains important information concerning S.A.L.T. dates, staff requirements, and information.
Again, if you find out that you are unable or unwilling to abide by S.A.L.T’s guidelines, policies
and staff requirements, please do not apply.
3. Carefully read instructions on reference forms. Please do not use a relative as a reference. If your
parent is your Pastor (Corps Officer), please use your Youth Pastor as your reference. PLEASE make
sure that the people filling out the reference forms know that your application will not be complete until
these forms are submitted.
4. Please fill out all sections on pages 5-12 completely. Pages 13-18 need to be given to references with
instructions for them to mail, fax or email them in. Make sure that all reference and employment
addresses, phone umbers and zip codes are correct. If we are unable to make contact with your
references, we will not be able to consider you for employment.
5. Please don’t hesitate to call us if you have any questions. E-mail is preferred and is the easiest way to
contact us if you have any questions. im.youth@usw.salvationarmy.org
2
STAFF REQUIREMENTS
SPIRITUAL COMMITMENT:
 Must be committed to Jesus as their Lord and Savior and demonstrate a growing Christian life by
modeling Christ-like behavior consistent with Biblical principles.
AVAILABILITY:
 Please note that preference is given to applicants with FULL SUMMER AVAILABILITY. Orientation
is mandatory and begins on June 2nd. Our final day will be August 6th.
AGE REQUIREMENTS:
 The age requirement is 14-15 years old
MEDICALPHYSICAL FITNESS:
 High Peak Camp is situated at a breathtaking 9,000 feet elevation. It is important that all staff be
physically able to handle life at that altitude – lots of walking, hiking, and physical activity. A physical
is required to ensure you are medically cleared to work in this environment. A Physical form will be
provided as part of the hiring packet and must be completed and submitted by May 15th (one within
the last 12 months is acceptable).
SMOKING, ALCOHOL, ILLEGAL DRUGS & CLUBBING:
 Our staff will not condone or personally use tobacco, illegal drugs or alcohol while employed both on
and off duty. Clubbing is not permitted. These are stumbling blocks to the youth that we desire to
reach (Hebrews 12:1-3, 1 Corinthians 8:9-13).
PERSONAL APPEARANCE:
 Be willing to maintain a well-groomed and clean-cut (cover tattoos, remove piercings, etc.)
appearance for the entirety of the summer contract.
 As a staff member it is important to be an example to the campers in dress as well as conduct. No
clothing may be worn which suggests or portrays behavior or activities that are inappropriate as a
servant of Christ.
PERSONAL COMMITMENT AND UNDERSTANDING:
 Please read Philippians 2:5-11. It is important to understand every ministry opportunity that you get
involved with will have its own set of policies, guidelines, and standards. Christ was willing to give up
all of His rights as Godhead, put Himself in a confining human body, suffer and die in it. As a member
of the High Peak Camp summer team you will be challenged to submit your rights and conform to the
ministry model that God has called you to. As you do, Christ will shine through you. Please do not
apply if you are unwilling to conform to High Peak Camp’s policies, guidelines, and standards.
3
PURPOSE:
The SALT program is a discipleship and mentoring program created to help strengthen the spiritual lives and leadership
abilities of the teens in our corps. This is a volunteer program for Christian young adults ages 14-15 which allows them to
be exposed to as many Camp and Youth Ministry responsibilities as possible while being supervised by a senior program staff
member.
PROGRAM REQUIREMENTS:
In order to participate, a contract must be signed by the SALT member, their parent, corps officer or pastor, and the Divisional
Youth & Candidates' Secretary. The contract requirements include keeping a daily journal, participating in regular Bible
studies, memorization of scripture verses, completion of program area work assignments, as well as active participation in
cabin group activities.
OBJECTIVES / GOALS:
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Equip young people with valuable life skills by providing job-related experience
Groom for staff teams of the future
Provide specific Salvation Army Camp a n d Y o u t h M inistry training and experience.
Promote spiritual development and discipleship
Promote social development: working and peer relationship
Promote mental development: self-esteem, help to create positive self-image
Promote emotional development: autonomy, appropriate relationships
In return for completion of contract requirements, each SALT member will receive a weekly stipend for each camp
completed and a grant at the successful completion of their session.
TEAM:
Team made up of six members and a staff leader will split time between assigned duties at High Peak Camp and the Traveling
VBS team.
Dates: 6 Weeks
 Orientation – June 2-8
 Traveling VBS – June 9-13
 RMYC #2 – June 16 – 21
 Traveling VBS – June 23-27
 Sports Camp – June 30-July 5
 Traveling VBS – July 7 - 11
TRANSPORTATION:
Transportation to Camp and to VBS Meeting places will be the responsibility of the team member. Transportation while at
Camp and while on VBS Trips will be Camp’s responsibility.
MEALS & LODGING:
All meals are provided while Camp is in session and while on VBS Trips. While at High Peak Camp, SALT members will
be assigned staff housing. While on VBS visits, teams will be billeted by host Corps. SALT members should bring pocket
money for extra snacks, drinks, souvenirs, etc.
4
PROGRAM AGREEMENT
This agreement is entered into by The Salvation Army High Peak Camp and
.
The signature of your parent(s), your pastor, the divisional youth secretary, and the above named crew member binds them to
the following terms of agreement:
Position: SALT Crew Member
Dates of Participation:
 Orientation – June 2-8
 Traveling VBS – June 9-13
 RMYC #2 – June 16 – 21
 Traveling VBS – June 23-27
 Sports Camp – June 30-July 5
 Traveling VBS – July 7 - 11
Stipend: $50.00 per week for 6 weeks. An additional $200.00 grant awarded dependent upon successful completion of the
program. Successful completion includes completing projects, submitting them to DHQ for review on time. This grant will be
paid in December 2014. Room & Board included.
Compliance with all written personnel policies and procedures and completion of the following SALT program components:
o Complete all Orientation components
o Plan, prepare and conduct VBS at assigned Corps locations
o Execute all SALT program and operational assignments at High Peak Camp
Commit to memory at least six assigned scripture verses Complete daily entries in your Prayer Journal
o Prepare and implement weekly Program assignments Complete all required Bible Study material and reading
and reflection assignments
o Actively participate in weekly discipleship groups
o Submit final program evaluation during your last week at camp
o Complete SALT projects from September through December 2014
I will abide by all policies and fulfill my responsibilities as outlined in the Summer Camp Staff manual. I agree to the
above conditions and will to the best of my ability fulfill the responsibilities listed on this agreement and will conduct
myself in a manner likely to bring honor and glory to God, and credit and respect to The Salvation Army.
This agreement is accepted to the above conditions:
SALT Crew Member:
Parent Guardian:
Corps Officer/Pastor:
Date
Date
Date
Divisional Youth Secretary:
Date
5
OFFICE USE ONLY
Date: _____/_____/_____
Rec’d by:________________
References Checked:_______
Position:_________________
Acceptance date: _________
Term date: _______________
High Peak Camp S.A.L.T. 2014 Application
PERSONAL INFORMATION
First Name:
Last Name
Mailing Address:
City:
State:
SS#:
DOB:
Zip Code:
Date:
E-Mail:
Facebook / Twitter website:
Cell Phone:
Home Phone:
Gender:
___ Male
Earliest date you can start:
T-shirt Size:
Age:
Ethnicity: (optional)
___ Female
Latest date you can stay:
Jacket Size:
PERSONAL & SPIRITUAL COMMITMENT (One additional page may be attached for answers if needed)
1. Describe how you became a Christian, your current relationship with Christ, and your present participation in ministry
activities:
2. What do you do to promote spiritual growth for yourself?
3. What specific strengths do you have to offer The Salvation Army’s Summer Camp Program?
4. List your leadership experiences and/or supervisory experiences:
REFERENCES
Corps Officer/Pastor:
Corps/Church:
Phone #:
Employer/Teacher/Friend:
Relation:
Phone #:
Employer/Teacher/Friend:
Relation:
Phone #:
6
EDUCATION
School Level
Number of
years
attended
Name and Location of School
Did you
graduate?
Subjects studied
Grammar School
High School
College
GENERAL
Areas of special study or research work
Special Training (CPR, Archery, Musician)
Special Skills (Music, Art, etc)
Please tell us anything else you think would be important for us to know:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
PAST EXPERIENCE (Camping or Youth Programs)
Camp/Corps/Church
Position
Supervisor
Phone
Camp/Corps/Church
Position
Supervisor
Phone
Camp/Corps/Church
Position
Supervisor
Phone
AGREEMENT
“Any applicant who knowingly or willfully makes false statements of any material fact or thing in this
application is guilty of perjury in the second degree as defined in section 18-8-503, C.R.S., and upon
conviction thereof, shall be punished accordingly.”
I attest that all the information provided is true. I have read, understand, and if hired, will comply with the
policies and procedures of The Salvation Army
Signature:
Date:
RETURN COMPLETED APPLICATION FORM TO:
The Salvation Army / Youth Department, P.O. Box 2369, Denver, CO 80201
7
CONFIDENTIAL
THE SALVATION ARMY
STATEMENT OF APPLICANT FOR EMPLOYMENT
INVOLVING WORK WITH CHILDREN *
This statement will be completed by all applicants for employment for any position involving the supervision or custody of
children (under 18 years of age) or for any position in which the applicant is in any way involved with children. The
completion of the statement will help to assure The Salvation Army that it will provide a safe and secure environment to
those children who participate in its programs and who use its facilities.
Personal Information
Name: __________________________________________________________________________________________
Last
First
Middle
Present Address: __________________________________________________________________________________
Street
City
State
Zip
Home Phone:
(________) _____________________
Social Security No.: __________ - _____ - __________
Cell Phone: (________) ______________________
Birth Date: _______/_______/_______
Education or training for work with children (List formal education courses and on the job training participated in,
identifying the institution).
Personal References (not relatives)
Name: ___________________________________
Name: __________________________________
Address: _________________________________
Address: ________________________________
________________________________________
________________________________________
Phone #: _________________________________
Phone #: ________________________________
All prior work with children (List the church or other organization conducting the program, the name of the immediate
supervisor and, if known, the name, address and telephone number of any individual now involved in the program.)
*
For purposes of this statement, the words “child” and “children” mean individuals below the age of 18 years.
8
STATEMENT OF APPLICANT FOR EMPLOYMENT INVOLVING WORK WITH CHILDREN
Statement
As the applicant described above, I do hereby represent to The Salvation Army, with the understanding that The Salvation
Army will rely upon the information provided in considering my application for work with children, that the foregoing
information and following statements are true:
1. In my prior employment, I have never used a name other than that set forth above.
□ YES □ NO
2. I understand the essential duties of my position in connection with the working with children in the
programs of The Salvation Army. I am able to perform those essential job duties with no
accommodation (please list any except).
___________________________________________________________________________
___________________________________________________________________________
□ YES □ NO
3. I have never been accused of abuse of a child or of actual or attempted sexual molestation of a
child, either in a program for children or otherwise. If the answer is “no”, please describe the
circumstances of the accusation and the outcome:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
□ YES □ NO
4. I have never been arrested as a result of a charge of child abuse or of actual or attempted sexual
molestation of a child.
□ YES □ NO
5. I have never been convicted of child abuse or of actual or attempted sexual molestation of a child.
□ YES □ NO
6. I authorize any of the churches or other organizations and their representatives and my personal
references listed above to give to The Salvation Army and information they may have regarding
my character and fitness for work with the children. I release all such organizations and
individuals from any liability that may result from their furnishing such information to The Salvation
Army. I waive any right that I may have to inspect any records containing such information.
□ YES □ NO
7. I am aware that The Salvation Army is a branch of the Christian Church and, in the event that my
application is accepted, I agree that I will conduct myself in my work with children in a way that is
consistent with the religious and charitable policies and principles of The Salvation Army.
□ YES □ NO
□ YES □ NO
8. Having provided the foregoing information and having affirmed the foregoing statements are true,
I agree that any false information or statements are punishable under the laws relating to perjury.
____________________________________________
Signature of Applicant
Date: _____/_____/_____
____________________________________________
Signature of Witness
Date: _____/_____/_____
____________________________________________
Name of Witness (Please Print)
Address of Witness: ______________________________________________________________
Street
City
State
Zip
9
HEALTH INSURANCE INFORMATION
Name: _______________________________________________ Date of Birth: _____/_____/ _____
Health Insurance Carrier: _________________________________________________________________
Health Insurance Address: ________________________________________________________________
City: __________________________________________ State: _____
Zip Code: _________________
Policy Number: ______________________ Group Number: ______________________________________
Name of Insured Person: __________________________________________________________________
PLEASE INCLUDE A COPY OF HEALTH INSURANCE CARD
UNDER 18 MEDICAL CONSENT
I, ________________________________________, parent/guardian of
__________________________________________, agree to pay for any medical expenses incurred by my
son/daughter during their summer employment at High Peak Camp. I give The Salvation Army/High Peak
Camp permission to take my son/ daughter to the hospital or clinic as deemed necessary. I give my consent
for any necessary medical treatment to be administered and agreed to pay for all medical expenses of this
treatment.
Signature: _____________________________________
Date: _________________
18 AND OLDER MEDICAL CONSENT
I, ______________________________________, agree to pay for any medical expenses incurred by myself
during my employment at High Peak Camp. I have included my medical insurance above. In the event I have
no medical insurance, then I understand that I am liable to pay for my personal medical expenses. I give The
Salvation Army/High Peak Camp permission to administer treatment as necessary.
Signature: _____________________________________
10
Date: ________________
EMERGENCY NOTIFICATION
Name of Employee: (Please print all information)
________________________________________________________________________________________
Emergency Contact Name: _____________________________________ Relationship: _________________
Address: ________________________________________________________________________________
City, State, Zip ___________________________________________________________________________
Cell: _______________________ Home Tel: _____________________ Work Tel: ______________________
Contact Email Address: ____________________________________________________________________
_____________________________
Applicant’s Signature
_____________________________
Print Name
____________________________________________________
Parent/Guardian’s Signature
____________________________________________________
Print Name
Date: _____/_____/_____
Date: _____/_____/_____
MINOR STAFF TRANSPORTATION RELEASE
I, _____________________________, as the Parent/Guardian of the staff member, give my permission for my
Son/ Daughter _____________________________ to:
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
Ride in any vehicle with any driver over the age of 18
Only ride with a specific member of staff:
____________________________
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
Only ride in camp approved vehicles on official camp
trips
Not ride in any vehicle unless it is an emergency
I understand that if my son or daughter is riding with another staff member, in a personal vehicle, the camp
assumes no responsibility for any injuries occurred while in that vehicle.
Signature: __________________________
Date: _____/_____/_____
MINOR STAFF VIDEO AND PHOTO RELEASE STATEMENT
I, ______________________________, as the Parent/Guardian of the staff member, give my permission for
my Son/Daughter ________________________________ to:
Appear in any video or photo taken at camp. I understand that any video or photo taken at camp will be
use for good intensions; including but not limit to promotion, education, and souvenirs.
Participate in The Salvation Army’s educational training video “Protecting the Mission,” within 90 days
of the date below. I understand the training video includes the subject of preventing child sexual abuse,
shows interviews with sexual predators explaining their misbehavior, and explains The Salvation
Army’s program to protect children. I understand that viewing these videos is a training requirement for
all Salvation Army Personnel (Officers, employees and volunteers) who work with minors.
Signature: __________________________
Date: _____/_____/_____
11
The Salvation Army Intermountain Division
Parental Disclosure for Minor Camp Hire
(For minor applicant only)
As the parent or legal guardian of
___________________________________________________, I hereby authorize him or her to
participate as a volunteer intern at High Peak Camp for the period of June to August, 2014.
I, __________________________________, as the parent or legal guardian of the above named
minor, agree to disclose to The Salvation Army any arrests or criminal convictions that my child
has had, with the understanding that if none are listed, that I affirmatively represent that I know of
no such arrests or criminal convictions for said minor.
Please list any arrests or convictions with approximate date and location
Please initial here if none: __________
______________________________________________________________________________
Parent or legal guardian name – please print
______________________________________________________________________________
Parent or legal guardian signature
______________________________________________________________________________
Parent or legal guardian complete street address
City: ______________________________________ State: ______
(_______)__________________________________
Parent or legal guardian phone number
_____/_____/_____
Date
12
Zip Code: __________
PASTOR REFERENCE EVALUATION
Section A – To be completed by applicant
Name of Reference:
Name of Applicant:
Position Applied For:
I hereby authorize any investigator or duly accredited representative of The Salvation Army bearing this release to obtain
any information from schools, residential management agents, employers, criminal justice agencies or individuals relating
to any activities. This information may include, but is not limited to, academic, residential, achievement, performance,
attendance, personal history, disciplinary, arrest, and conviction records. I hereby direct you to release such information
upon request of the bearer.
I hereby release any individual, including record custodians, from any and all liability for damages of whatever kind or
nature, which may at any time result to me on account of compliance, or any attempts to comply, with this authorization.
Applicant’s Signature:
Date:
Section B – To be completed by reference
The above named applicant is applying for a position at High Peak Camp. This position requires close contact with children. Because
safety of the children in our care is of utmost importance, the camp administration finds candid, thorough evaluations invaluable to the
decision making process. Please include any information you feel is pertinent, and remember that your prompt appraisal of the
candidate will help ensure full consideration. Please fill it out and return to the address below under confidential cover. Faxes are
accepted with the original to follow by mail. Your statements will not be shared with the applicant. Statements are considered as a
whole in respect to the position applied for, and do not individually constitute immediate consideration nor disqualification. Thank you.
Please rate the applicant in the following areas.
Please be realistic and honest in your judgment.
Superior
Above
Average
Average
Below
Average
Does Not
Apply or
Have not
Observed
Leadership
Dependability
Emotional Stability & Self Esteem
Ability to work with others
Personal Integrity
Spiritual Influence
Respect For Others
Follows Directions
Communication Skills
Patience
Flexibility
Ability to work with children
Relates to people of diverse cultures
Maturity & Judgment
Spiritual Commitment
Commitment to your Corps or Church
Please send the completed Reference Evaluation Form to:
The Salvation Army – Youth Department
P.O. Box 2369
Denver, CO 80201
13
OR email the forms to:
im.youth@usw.salvationarmy.org
Pastor Reference Continued
What strengths does this applicant possess pertaining to the position applied for?
In what areas could the applicant improve?
How is the applicant involved in your Corps/church (ministry etc.)?
To the best of your knowledge is there any fact or circumstance in the applicant’s background that would call into question
his/her ability to supervise, guide, and care for the young people being entrusted into his/her care? Y / N
If yes, please explain:
In your opinion, is there any reason to suspect that this applicant may intentionally or unintentionally harm a child
physically, sexually, verbally, or emotionally? Y/ N
If yes, please explain:
Would you leave your child in the care of this applicant? Y / N
How long and in what capacity do you know this applicant?
Please write any other comments:
I (choose one)…



Recommend
Do Not Recommend
Recommend With Reservation
…this applicant for a position at The Salvation Army Camp at High Peak.
Print Name
Title
Signature
Date
Phone Number
E-mail
We would like to talk with you by phone. When would be the best time of day to contact you? ___________________
14
PERSONAL REFERENCE EVALUATION
Section A – To be completed by applicant
Name of Reference:
Name of Applicant:
Position Applied For:
I hereby authorize any investigator or duly accredited representative of The Salvation Army bearing this release to obtain
any information from schools, residential management agents, employers, criminal justice agencies or individuals relating
to any activities. This information may include, but is not limited to, academic, residential, achievement, performance,
attendance, personal history, disciplinary, arrest, and conviction records. I hereby direct you to release such information
upon request of the bearer.
I hereby release any individual, including record custodians, from any and all liability for damages of whatever kind or
nature, which may at any time result to me on account of compliance, or any attempts to comply, with this authorization.
Applicant’s Signature:
Date:
Section B – To be completed by reference
The above named applicant is applying for a position at High Peak Camp. This position requires close contact with children. Because
safety of the children in our care is of utmost importance, the camp administration finds candid, thorough evaluations invaluable to the
decision making process. Please include any information you feel is pertinent, and remember that your prompt appraisal of the
candidate will help ensure full consideration. Please fill it out and return to the address below under confidential cover. Faxes are
accepted with the original to follow by mail. Your statements will not be shared with the applicant. Statements are considered as a
whole in respect to the position applied for, and do not individually constitute immediate consideration nor disqualification. Thank you.
Please rate the applicant in the following areas.
Please be realistic and honest in your judgment.
Superior
Above
Average
Average
Below
Average
Does Not
Apply or
Have not
Observed
Leadership
Dependability
Emotional Stability & Self Esteem
Ability to work with others
Personal Integrity
Spiritual Influence
Respect For Others
Follows Directions
Communication Skills
Patience
Flexibility
Ability to work with children
Relates to people of diverse cultures
Maturity & Judgment
Spiritual Commitment
Commitment to your Corps or Church
Please send the completed Reference Evaluation Form to:
The Salvation Army – Youth Department
P.O. Box 2369
Denver, CO 80201
15
OR email the forms to:
im.youth@usw.salvationarmy.org
Personal Reference Continued
What strengths does this applicant possess pertaining to the position applied for?
In what areas could the applicant improve?
How is the applicant involved in your Corps/church (ministry etc.)?
To the best of your knowledge is there any fact or circumstance in the applicant’s background that would call into question
his/her ability to supervise, guide, and care for the young people being entrusted into his/her care? Y / N
If yes, please explain:
In your opinion, is there any reason to suspect that this applicant may intentionally or unintentionally harm a child
physically, sexually, verbally, or emotionally? Y/ N
If yes, please explain:
Would you leave your child in the care of this applicant? Y / N
How long and in what capacity do you know this applicant?
Please write any other comments:
I (choose one)…



Recommend
Do Not Recommend
Recommend With Reservation
…this applicant for a position at The Salvation Army Camp at High Peak.
Print Name
Title
Signature
Date
Phone Number
E-mail
We would like to talk with you by phone. When would be the best time of day to contact you? ___________________
16
PERSONAL REFERENCE EVALUATION
Section A – To be completed by applicant
Name of Reference:
Name of Applicant:
Position Applied For:
I hereby authorize any investigator or duly accredited representative of The Salvation Army bearing this release to obtain
any information from schools, residential management agents, employers, criminal justice agencies or individuals relating
to any activities. This information may include, but is not limited to, academic, residential, achievement, performance,
attendance, personal history, disciplinary, arrest, and conviction records. I hereby direct you to release such information
upon request of the bearer.
I hereby release any individual, including record custodians, from any and all liability for damages of whatever kind or
nature, which may at any time result to me on account of compliance, or any attempts to comply, with this authorization.
Applicant’s Signature:
Date:
Section B – To be completed by reference
The above named applicant is applying for a position at High Peak Camp. This position requires close contact with children. Because
safety of the children in our care is of utmost importance, the camp administration finds candid, thorough evaluations invaluable to the
decision making process. Please include any information you feel is pertinent, and remember that your prompt appraisal of the
candidate will help ensure full consideration. Please fill it out and return to the address below under confidential cover. Faxes are
accepted with the original to follow by mail. Your statements will not be shared with the applicant. Statements are considered as a
whole in respect to the position applied for, and do not individually constitute immediate consideration nor disqualification. Thank you.
Please rate the applicant in the following areas.
Please be realistic and honest in your judgment.
Superior
Above
Average
Average
Below
Average
Does Not
Apply or
Have not
Observed
Leadership
Dependability
Emotional Stability & Self Esteem
Ability to work with others
Personal Integrity
Spiritual Influence
Respect For Others
Follows Directions
Communication Skills
Patience
Flexibility
Ability to work with children
Relates to people of diverse cultures
Maturity & Judgment
Spiritual Commitment
Commitment to your Corps or Church
Please send the completed Reference Evaluation Form to:
The Salvation Army – Youth Department
P.O. Box 2369
Denver, CO 80201
17
OR email the forms to:
im.youth@usw.salvationarmy.org
Personal Reference Continued
What strengths does this applicant possess pertaining to the position applied for?
In what areas could the applicant improve?
How is the applicant involved in your Corps/church (ministry etc.)?
To the best of your knowledge is there any fact or circumstance in the applicant’s background that would call into question
his/her ability to supervise, guide, and care for the young people being entrusted into his/her care? Y / N
If yes, please explain:
In your opinion, is there any reason to suspect that this applicant may intentionally or unintentionally harm a child
physically, sexually, verbally, or emotionally? Y/ N
If yes, please explain:
Would you leave your child in the care of this applicant? Y / N
How long and in what capacity do you know this applicant?
Please write any other comments:
I (choose one)…



Recommend
Do Not Recommend
Recommend With Reservation
…this applicant for a position at The Salvation Army Camp at High Peak.
Print Name
Title
Signature
Date
Phone Number
E-mail
We would like to talk with you by phone. When would be the best time of day to contact you? ___________________
18