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2012 Application
Summer Ministry Team Application
Summer Ministry Team Application
Application
Nebraska Lutheran Outdoor Ministries assures equal opportunity to all applicants and employees without regard to race, color, age, national origin, disability, marital status or creed. NLOM does withhold the right to base employment decisions on religious beliefs.
Full Name
Name you go by
Current Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Columbia (District of)
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Phone Number
Cell Phone
E-mail Address
Parent/Permanent Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Columbia (District of)
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Phone Number
Birthday
Are you a U.S. citizen or authorized to work in the U.S.?
YES
No
Do you have a current drivers license?
Yes
No
Shirt size: Unisex sizing
Small
Medium
Large
XL
XXL
XXXL
Certification & Experience
Please check current certifications. A copy of your current certification cards will be needed.
Current Red Cross Standard First Aid Certification
Yes
Current CPR Certification
Yes
If you are CPR certified, when does your certification expire?
Can you play guitar?
Yes
No
Do you have current Lifeguard certification?
Yes
No
Would you be willing to get lifeguard certified?
Yes
No
Other Certifications?
Do you have any special interests or hobbies you think might be helpful for summer ministry?
Do you have any experience working with (check the boxes that are yes):
K-2nd
3rd-5th
6th-8th
9th-12th
Youth with special needs
Adults with developmental disabilities
Desired Position
Other options:
Are you available for the full summer? (May 23 - July 30)
Yes
No
Please list conflicting dates
References
Select three individuals to serve as references. Do not use family members or peers. One reference must be clergy. List the references on the application. It is your responsibility to contact your references and have them complete the reference form. They can do this on line or download the form and mail it in. Reference forms should be sent by e-mail, mail or fax directly to the camp and not returned to the summer staff applicant. Staff can not be officially hired until all three reference forms are received by NLOM.
Teacher or Employer
School or company name
Phone number of reference
E-mail address of reference
_________________________________________________________________
Pastor/Youth Minister
Church or Agency
Phone Number of reference
E-mail address of reference
_________________________________________________________________
Other Adult: This should be someone that has observed you working with children
Agency or Business
Phone Number of reference
E-mail address of reference
Educational Record: Give your complete educational history, prior to Spring 2011.
High School Graduate or Equivalent?
Yes
No
If yes, what was the date of your graduation?
College, University or Vocational School 1
City/State
Major/Degree
Dates
__________________________________________________________________
College, University or Vocational School 2
City, State
Major/Degree
Dates
Occupational Goal
Church Affiliation
Church Affiliation: We are a church camp. Bible study, worship and prayer are part of daily life at camp. Staff are expected to talk with campers, share their faith and participate fully in the program.
Church
Denomination
Church Address
City, State, Zip Code
Pastor's Name
Number of years he/she has known you?
_________________________________________________________________
Church of attendance while at college
Denomination
Pastor's Name
Other faith-based organizations you are involved in
Camp Experience
List any camps you attended or worked at as staff.
Camper or Staff?
Camper
Staff
Camp
Agency
City/State
__________________________________________________________________
Camper or Staff?
Camper
Staff
Camp
Agency
City/State
Employment Record
List your four most recent paid positions. These businesses may be contacted for verification of employment and performance appraisal.
Firm or Employer
Dates of Employment
Position
__________________________________________________________________
Firm Name or Employer
Dates of Employment
Position
__________________________________________________________________
Firm Name or Employer
Dates of Employment
Position
Firm Name or Employer
Dates of Employment
Position
Only those who haven't served on the NLOM Summer Ministry Team before are asked to answer the following questions.
Briefly explain your faith story. Please include people and experiences that have shaped your beliefs.
Please limit your response to 250 words.
Please share your personal mission statement for the summer and why you want to be a part of the Christian ministry with Nebraska Lutheran Outdoor Ministries.
Please limit your response to 250 words.
Rehire Questions
Anyone who has served on the NLOM Summer Ministry Team in the past is required to answer the following question.
If you returned for another summer, how would you find the energy and challenge in those things that are the same, and still adapt to those things that will change?
Please limit your response to 250 words
Why do you want to return to ministry at Nebraska Lutheran Outdoor Ministries and what goals will you set for yourself this summer?
Please limit your response to 250 words
Authorization and Understanding
1. Have you ever been charged, convicted of, or pled guilty to a crime, either a misdemeanor or a felony (including but not limited to drug-related charges, child abuse, unlawful sexual offense, other crimes of violence, or motor vehicle violations)?
Yes
No
If yes, please explain
2. I certify that the statements made on this application now and hereafter in support of my application are accurate and true. I understand misrepresentation of facts in this application or interview will disqualify me for further consideration, or if I am employed by NLOM, may be sufficient cause for dismissal.
3. NLOM has my permission to verify any information given with the appropriate individuals or companies and I authorize NLOM to release any information requested by any of my prospective or subsequent employers without any obligation to give me written notice of such disclosure unless I notify NLOM in writing, to release employment dates only.
4. I authorize NLOM to receive information that may be listed on the Nebraska Child Abuse and Neglect Central Registry to confirm that there have been no substantiated referrals of child maltreatment concerning me. I also give NLOM permission to contact courts and law enforcement agencies to gather necessary information concerning past violations and arrests.
5. I give NLOM permission to use any photographs/video of me taken at camp in future promotion of NLOM.
7. I understand employment is contingent upon the agency’s verification of my employment and identity. I understand that it will be necessary for me to submit such documents as are required by law to verify my identification and employment authorization on the first day of employment.
6. I am aware that Nebraska Lutheran Outdoor Ministries is a serving arm of the Evangelical Lutheran Church in America and agree to abide by and uphold its mission, ideals, rules, regulations and policies.
Date of Authorization and Understanding
Initials: this serves as your signature to this section and will hold up in a court of law.
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Summer Ministry Team
Application Process
2012 Application
Reference Form
2012 Positions Available
Important 2012 Dates
Why Serve?
Site Coordinator Application
27416 Ranch Road, Ashland, NE 68003 • 1-402-944-2544