Name:Date: MoDay Yr
Home Address:Phone:School Address:
*Please indicate at which address you would prefer to receive your mail.U.S. Mail E-MailParent or Guardians Full Name
Name of School Attending:
Present Grade or Class: Major:
Pastor:Will you be 18 as of June 1? Yes No
Will you be 21 as of June 1? Yes No
Please list two persons as references (preferably past employers):Name 1: Relationship:
Name 2: Relationship:
Address2: Phone:List any swimming or First-Aid certificates that you currently hold:
Applying for the following positions in order of preference:1. 2.
Will fill any position.
List any medical conditions that might affect your work:
Special Skills & Abilities: Check all that apply
What do you expect from Luther Park?
What experience have you had working with children and youth?
What does "Grace" mean to you?
What part does your faith play in your life right now?
How do you let others know what you believe?
What is your leadership style?
How do you like to spend your free time?
Have you ever been convicted of a crime against a child?