Summer Staff
Application Package
Dear Applicant:
High Peak Camp is a Christian camp. Our summer staff is made up of committed Christians who
appreciate kids and love 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:







Application Instructions
Staff Requirements
Application Form
Statement of Applicant for Employment Involving Work With Children
Background Check Consent Form Sterling - for Adults Only
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
Intermountain Youth Department @ (303) 866-9298
or im.youth@usw.salvationarmy.org
Blessings,
Lieutenant Peter Pemberton
Divisional Youth & Candidates’ Secretary
Intermountain Division
High Peak Camp’s Mission Statement
High Peak Camp • Summer Staff Application Package • Page 1
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 High Peak Camp by
April 3rd. 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 45 minutes to an hour to complete High Peak Camp’s 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 camp dates, staff requirements, and information.
Again, if you find out that you are unable or unwilling to abide by High Peak Camp’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 a local officer 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 4-14 completely. Pages 15-20 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 numbers 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
Staff Requirements
High Peak Camp • Summer Staff Application Package • Page 2
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 May 27th for Program Staff and June 1st for Support and Counseling Staff. Our
final day will be August 4th.
Age Requirements:
The age requirement varies depending on the position apply for. All minor staff must have turned 16 by June
1st. Please refer to each position for the desired age.
Fees:
Travel: You are responsible for your travel to High Peak Camp. We are working on offering a list of ways
concerning ground transportation from the airport or bus station.
J-1 Visa: International staff members will need to secure employment through Camp America.
Medical Physical 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 8th (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 12:13, 1 Corinthians 8:9-13).
Personal Appearance:
Be willing to maintain a well-groomed and clean-cut apperance (cover tattoos, remove piercings, etc.) 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. (Please see
section “Appearance” in the Employee Handbook – for appropriate attire).
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.
High Peak Camp • Summer Staff Application Package • Page 3
Summer
Employment
Application
OFFICE USE ONLY
Date: ____/____/____
Rec’d by:________________________
References Checked:_______________
Position:________________________
Pay Rate:_______________________
Effective hire date: _______________
Term date: ______________________
Personal Information
First Name:
Middle Name:
Last Name:
City:
State:
Zip:
Cell Phone:
Home Phone:
Email Address:
Mailing Address:
SSN #:
Date of Birth:
Gender
___ Male ____ Female
Ethnicity (optional):
Earliest date you can start:
Latest date you can stay:
T-Shirt
Size:
Are you 18 years or older?
____Yes ____No
Jacket
Size:
Personal & Spiritual Commitment (One additional page may be attached for answers if needed)
1. Describe your current relationship and personal commitment to Jesus Christ.
2. In what ways do you attempt to share Christ with others?
3. What are you currently doing to grow as a follower of Christ?
4. What are three things your friends really like about you?
5. What are three things your friends would change about you?
6. How would you describe salvation to a camper?
High Peak Camp • Summer Staff Application Package • Page 4
7. Why is the outdoors an important setting for ministry?
8. Why do you want to serve with High Peak Camp?
References
Corps Officer / Pastor:
Corps/Church:
Phone #:
Employer / Teacher / Friend:
Relation:
Phone #:
Employer / Teacher / Friend:
Relation:
Phone #:
Education
School Level
Number of
years attended
Name & Location of School
Did you
graduate?
Subjects studied
Grammar
High School
College
Trade, Business or
Correspondence
General
Areas of special study or research work
Special Training
Special Skills
Please tell us anything else you think would be important for us to know:
Certifications (Check off any and all certifications that you currently hold.)
___ First Aid
___ CPR
___ Lifeguard
___ WSI
___ EMT
___ CDL
___WFR
___ WFA
___ CPR-PR
Other:
___ RN
___ LPN
High Peak Camp • Summer Staff Application Package • Page 5
Former Employers (list below last three employers, starting with the most recent one first)
Name of present or last employer
Address
City
State
Zip
Starting Date
Leaving Date
Job Title
Weekly Starting Salary
Weekly Final Salary
May we contact your supervisor
____ Yes _____ No
Name of Supervisor
Title
Phone
Address
City
State
Starting Date
Leaving Date
Job Title
Weekly Starting Salary
Weekly Final Salary
May we contact your supervisor
____ Yes _____ No
Name of Supervisor
Title
Phone
Address
City
State
Starting Date
Leaving Date
Job Title
Weekly Starting Salary
Weekly Final Salary
May we contact your supervisor
____ Yes _____ No
Name of Supervisor
Title
Phone
Description of work
Reason for leaving
Name of previous employer
Zip
Description of work
Reason for leaving
Name of previous employer
Zip
Description of work
Reason for leaving
High Peak Camp • Summer Staff Application Package • Page 6
Service Record (Military)
Branch of Service
Rank
Discharge Date
Branch of Service
Rank
Discharge Date
Leadership/Ministry Experience
List paid and volunteer ministry or leadership experiences you have had and explain your basic responsibilities.
Organization
Position
Supervisor
Address
Phone
Dates
Age group served
Responsibilities:
Camp/Corps/Church
Supervisor
Position
Address
Phone
Dates
Age group served
Responsibilities:
Camp/Adventure Program Staff Experience
List any camp experience you have had and explain your basic responsibilities.
Organization
Position
Supervisor
Address
Phone
Dates
Supervisor
Responsibilities:
Organization
Position
Supervisor
Address
Phone
Dates
Supervisor
Responsibilities:
Skills
Rate your experience and/or interest
in any of the areas listed below.
I = Interest (I have no experience but am interested in learning how to lead this activity)
E = Experience (I have experience but need more training to lead this activity)
P = Proficient (I have extensive experience and training, and am able to lead this activity)
Ropes Course
Rock
Climbing
Mtn. Biking
GPS
Skits
Hiking
Orienteering
Archery
Life Guarding
Swimming
Bible Study
Frisbee Golf
Nature Study
Low Ropes
Teaching
Administration
Campfire
Programs
Team
Building
Worship
Leading
Singing
Guitar
Other
Instrument
Court &
Field Sports
Arts & Crafts
Age Groups: Rate your experience and/or ability to teach and lead in EACH of the age groups listed below.
0 = No Experience 1 = Little Experience 2 = Some Experience 3 = A Lot of Experience
_____ Elementary _____ Jr. High _____ Sr. High
High Peak Camp • Summer Staff Application Package • Page 7
Summer Staff Job Opportunities
Please note First, Second, and Third Choices (write the numbers 1, 2 & 3 in the box next to the position)
Asst. Program
Director
Program Aide
Head Dining/
Kitchen Staff
Arts & Craft
Director
Head
Counselor
Dining/ Kitchen
Staff
Outdoor Education
Specialist
Wilderness Camp
Counselor
Maintenance
Waterfront
Director
Counselor
Recreation
Director
Camp Nurse
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 stated in the Summer Camp Employee Handbook. I also understand that The Salvation
Army will perform a full background check (for minor, Parental Disclosure Form will be signed).
Signature:
Date:
RETURN COMPLETED APPLICATION FORM (pages 4-14) TO:
The Salvation Army
Attn: Youth Department / Camp Application
P.O. Box 2369
Denver, CO 80201
CONFIDENTIAL
THE SALVATION ARMY
STATEMENT OF APPLICANT FOR EMPLOYMENTINVOLVING WORK WITH CHILDREN *
High Peak Camp • Summer Staff Application Package • Page 8
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.
High Peak Camp • Summer Staff Application Package • Page 9
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.
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).
___________________________________________________________________________
___________________________________________________________________________
3.
□ YES □ NO
□ YES □ NO
□ YES □ NO
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:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
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.
5.
I have never been convicted of child abuse or of actual or attempted sexual molestation of a
child.
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
□ YES □ NO
□ 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
□ YES □ NO
that is consistent with the religious and charitable policies and principles of The Salvation Army.
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: _____/_____/_____
□ YES □ NO
____________________________________________
Name of Witness (Please Print)
Address of Witness: ______________________________________________________________
Street
City
State
Zip
High Peak Camp • Summer Staff Application Package • Page 10
(For applicants 18 years and older)
Consent to Request Consumer Report & Investigative Consumer Report Information
Applicant's First Name or Initial
Last Name
I understand that The Salvation Army (TSA) will use Sterling InfoSystems Inc., 249 West 17th Street, New York, NY 10011,
(877) 424-2457 to obtain a consumer report and/or investigative consumer report (“Report”) as part of the hiring process. I also
understand that if hired, to the extent permitted by law, TSA may obtain further Reports from STERLING so as to update, renew or
extend my employment.
I understand Sterling InfoSystems Inc.’s (“STERLING”) investigation may include obtaining information regarding my credit
background, bankruptcies, lawsuits, judgments, paid tax liens, unlawful detainer actions, failure to pay spousal or child support,
accounts placed for collection, character, general reputation, personal characteristics and standard of living, driving record and
criminal record, subject to any limitations imposed by applicable federal and state law.
I understand such information may be
obtained through direct or indirect contact with former employers, schools, financial institutions, landlords and public agencies or
other persons who may have such knowledge. If an investigative consumer report is being requested, I understand such information
may be obtained through any means, including but not limited to personal interviews with my acquaintances and/or associates or
with others whom I am acquainted.
The nature and scope of the investigation sought is indicated by the selected services below: (Employer Use Only)
 Criminal Background Check
 SSN Trace
 Motor Vehicle Report
 Consumer Credit Report
 Other Please List:
 Education Verification
 Employment Verification
 Personal Reference
 Professional License/Certification
 Sex Offender Search
 OFAC/Terrorist Watch List
 Fraud & Abuse Control Info System (FACIS®)
 Office of Inspector General Sanctions (OIG)
I acknowledge receipt of the attached summary of my rights under the Fair Credit Reporting Act and, as required by law, any related
state summary of rights (collectively “Summaries of Rights”).
This TSA makes a conditional decision to disqualify me based all or in part on my Report, I will be provided with a copy of the Report
and another copy of the Summaries of Rights, and if I disagree with the accuracy of the purported disqualifying information in the
Report, I must notify TSA within five business days of my receipt of the Report that I am challenging the accuracy of such
information with STERLING.
I hereby consent to this investigation and authorize TSA to procure a Report on my background.
In order to verify my identity for the purposes of Report preparation, I am voluntarily releasing my date of birth, social security
number and the other information and fully understand that all employment decisions are based on legitimate non-discriminatory
reasons.
The name, address and telephone number of the nearest unit of the consumer reporting agency designated to handle inquiries
regarding the investigative consumer report is:
Sterling Infosystems, Inc. | 249 W 17th St. 6th Floor, New York, NY 10011 | 877-424-2457 | or | 5750 West Oaks Boulevard, Ste. 100
Rocklin, CA 95765 | 800-943-2589 |
___________________________________________________________________________________________________________
_______________________________________________________________________________
Signature:
_______________
Today’s Date:
Intermountain Division – The Salvation Army
www.sterlinginfosystems.com
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9/2012
High Peak Camp • Summer Staff Application Package • Page 11
For Office Use Only – Group ID (optional)
For Office Use Only – User ID (optional)
For Office Use Only – Location / Store # (optional)
First Name
Middle Name or Initial
Last Name
Date of Birth (MMDDYYYY)
Other Names Known By
Social Security Number
Male
Primary Telephone Number (no dashes)
Current Address
City
Female
Apt #
State
Previous Address
Zip Code
Apt #
City
State
Driver’s License Number (no dashes)
License State
#yrs at this address
#yrs at this address
Zip Code
Email Address
Signature
Today’s Date (MMDDYYYY)
High Peak Camp • Summer Staff Application Package • Page 12
Para informacion en espanol, visite www.consumerfinance.gov/learnmore o escribe a la
Consumer Financial Protection Bureau, 1700 G Street N.W., Washington, DC 20006.
A Summary of Your Rights Under the Fair Credit Reporting Act
The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer
reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as
agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your
major rights under the FCRA. For more information, including information about additional rights, go to
www.consumerfinance.gov/learnmore or write to: Consumer Financial Protection Bureau, 1700 G Street N.W., Washington,
DC 20006.
• You must be told if information in your file has been used against you. Anyone who uses a credit report or another type of
consumer report to deny your application for credit, insurance, or employment – or to take another adverse action against you – must
tell you, and must give you the name, address, and phone number of the agency that provided the information.
• You have the right to know what is in your file. You may request and obtain all the information about you in the files of a
consumer reporting agency (your “file disclosure”). You will be required to provide proper identification, which may include your
Social Security number. In many cases, the disclosure will be free. You are entitled to a free file disclosure if:
• a person has taken adverse action against you because of information in your credit report;
• you are the victim of identity theft and place a fraud alert in your file;
• your file contains inaccurate information as a result of fraud;
• you are on public assistance;
• you are unemployed but expect to apply for employment within 60 days.
In addition, all consumers are entitled to one free disclosure every 12 months upon request from each nationwide credit bureau and
from nationwide specialty consumer reporting agencies. See www.consumerfinance.gov/learnmore for additional information.
• You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness based on
information from credit bureaus. You may request a credit score from consumer reporting agencies that create scores or distribute
scores used in residential real property loans, but you will have to pay for it. In some mortgage transactions, you will receive credit
score information for free from the mortgage lender.
• You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is
incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your dispute is
frivolous. See www.consumerfinance.gov/learnmore for an explanation of dispute procedures.
• Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information. Inaccurate,
incomplete or unverifiable information must be removed or corrected, usually within 30 days. However, a consumer reporting
agency may continue to report information it has verified as accurate.
• Consumer reporting agencies may not report outdated negative information. In most cases, a consumer reporting agency
may not report negative information that is more than seven years old, or bankruptcies that are more than 10 years old.
• Access to your file is limited. A consumer reporting agency may provide information about you only to people with a valid need –
usually to consider an application with a creditor, insurer, employer, landlord, or other business. The FCRA specifies those with a
valid need for access.
• You must give your consent for reports to be provided to employers. A consumer reporting agency may not give out
information about you to your employer, or a potential employer, without your written consent given to the employer. Written
consent generally is not required in the trucking industry. For more information, go to www.consumerfinance.gov/learnmore.
www.sterlinginfosystems.com
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High Peak Camp • Summer Staff Application Package • Page 13
• You may limit “prescreened” offers of credit and insurance you get based on information in your credit report. Unsolicited
“prescreened” offers for credit and insurance must include a toll-free phone number you can call if you choose to remove your name
and address from the lists these offers are based on. You may opt-out with the nationwide credit bureaus at 1-888-567-8688.
• You may seek damages from violators. If a consumer reporting agency, or, in some cases, a user of consumer reports or a
furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue in state or federal court.
• Identity theft victims and active duty military personnel have additional rights. For more information, visit
www.consumerfinance.gov/learnmore.
States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may have more
rights under state law. For more information, contact your state or local consumer protection agency or your state Attorney
General. For information about your federal rights, contact:
TYPE OF BUSINESS:
CONTACT:
1.a. Banks, savings associations, and credit unions with total assets of over $10
billion and their affiliates.
a. Bureau of Consumer Financial Protection
1700 G Street NW
Washington, DC 20006
b. Such affiliates that are not banks, savings associations, or credit unions also
should list, in addition to the Bureau:
b. Federal Trade Commission: Consumer Response Center – FCRA
Washington, DC 20580 (877) 382-4357
2. To the extent not included in item 1 above:
a. National banks, federal savings associations, and federal branches and
federal agencies of foreign banks
a. Office of the Comptroller of the Currency
Customer Assistance Group 1301 McKinney Street, Suite 3450 Houston, TX
77010-9050
b. State member banks, branches and agencies of foreign banks (other than
federal branches, federal agencies, and insured state branches of foreign banks),
commercial lending companies owned or controlled by foreign banks, and
organizations operating under section 25 or 25A of the Federal Reserve Act
b. Federal Reserve Consumer Help Center
P.O. Box 1200 Minneapolis, MN 55480
c. Nonmember Insured Banks, Insured State Branches of Foreign Banks, and
insured state savings associations
c. FDIC Consumer Response Center
1100 Walnut Street, Box #11 Kansas City, MO 64106
d. Federal Credit Unions
d. National Credit Union Administration Office of Consumer Protection (OCP)
Division of Consumer Compliance and Outreach (DCCO) 1775 Duke Street
Alexandria, VA 22314
Asst. General Counsel for Aviation Enforcement & Proceedings Department of
Transportation 400 Seventh Street SW Washington, DC 20590
3. Air carriers
4. Creditors Subject to Surface Transportation Board
Office of Proceedings, Surface Transportation Board Department of Transportation
1925 K Street NW Washington, DC 20423
5. Creditors Subject to Packers and Stockyards Act
Nearest Packers and Stockyards Administration area supervisor
6. Small Business Investment Companies
Associate Deputy Administrator for Capital Access United States Small Business
Administration 406 Third Street, SW, 8th Floor Washington, DC 20416
7. Brokers and Dealers
Securities and Exchange Commission 100 F St NE
20549
Farm Credit Administration
1501 Farm Credit Drive Mclean, VA 22102-5090
8. Federal Land Banks, Federal Land Bank Associations, Federal Intermediate
Credit Banks, and Production Credit Associations
9. Retailers, Finance Companies, and All Other Creditors Not Listed Above
Washington, DC
FTC Regional Office for region in which the creditor operates or Federal
Trade Commission: Consumer Response Center – FCRA Washington, DC
20580 (877) 382-4357
www.sterlinginfosystems.com
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09/2012
High Peak Camp • Summer Staff Application Package • Page 14
PASTOR REFERENCE EVALUATION
Section A. To be completed by the 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 Signature: _____________________________________________ Date: __________________
Section B. To be completed by the 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
Continued on next page
High Peak Camp • Summer Staff Application Package • Page 15
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? _____________
Please send the completed Reference Evaluation Form to:
The Salvation Army
Attn: Youth Department / Camp Applicant Reference
P.O. Box 2369 • Denver, CO 80201
or email it to im.youth@usw.salvationarmy.org
High Peak Camp • Summer Staff Application Package • Page 16
PERSONAL REFERENCE EVALUATION
Section A. To be completed by the 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 Signature: _____________________________________________ Date: __________________
Section B. To be completed by the 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
Continued on next page
High Peak Camp • Summer Staff Application Package • Page 17
Personal Reference Continued
What strengths does this applicant possess pertaining to the position applied for?
In what areas could the applicant improve?
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? _____________
Please send the completed Reference Evaluation Form to:
The Salvation Army
Attn: Youth Department / Camp Applicant Reference
P.O. Box 2369 • Denver, CO 80201
or email it to im.youth@usw.salvationarmy.org
High Peak Camp • Summer Staff Application Package • Page 18
PERSONAL REFERENCE EVALUATION
Section A. To be completed by the 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 Signature: _____________________________________________ Date: __________________
Section B. To be completed by the 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
Continued on next page
High Peak Camp • Summer Staff Application Package • Page 19
Personal Reference Continued
What strengths does this applicant possess pertaining to the position applied for?
In what areas could the applicant improve?
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? _____________
Please send the completed Reference Evaluation Form to:
The Salvation Army
Attn: Youth Department / Camp Applicant Reference
P.O. Box 2369 • Denver, CO 80201
or email it to im.youth@usw.salvationarmy.org
High Peak Camp • Summer Staff Application Package • Page 20