Full Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Cell Phone/Home Phone *

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Please check your top two preferences for serving on staff *

Program Coordinator

Op-staff Counselor

Counselor

Co-counselor

Photographer

Op-staff

Time Commitment *

Please note that Staff Training is required for all staff

Entire Summer: June 9-August 8

First half: June 9-July 11

Second half: June 9-13, July 14-Aug 8

Reference 1: Phone *

(###)

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Reference 2: Phone *

(###)

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Reference 3: Phone *

(###)

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Please check the boxes and sign electronically below

You can access Pioneer Bible Camp's Statement of Faith here.

The information in this application is correct to the best of my knowledge

I authorize all references to disclose any information they have regarding my character and fitness for working at PBC.

I understand that as a part of the application process, I consent to a criminal background check.

I agree with Pioneer Bible Camp's Statement of Faith.

Date

MM

DD

YYYY