Counselor application form

Personal Information

Name:Date Today:Email:Address:Cell Phone:Other Phone:

Date of Birth:Age:Marital Status:License Number (If Applicable):T-shirt Size:Church Membership:

Position Applied for:Full Time CounselorPart Time/Substitute CounselorJunior Counselor (Volunteer)

Work Shift applied for (Full Time Counselors only):7:30 - 4:308:30 - 5:30

Age Group applied for (Full time Counselors only):Kindergarten-2nd Grade3rd-5th GradeMiddle School

Education Information

Name of Highschool:

Name of College/Technical:

Work ExperiencePlease list your last 3 jobs/most recent employment first (if applicable)

Please describe any volunteer work or related experience you have had with children:Please complete as thoroughly as possible1. The mission of Grey Stone Church is for the members and employees to have a personal relationship with the Lord. Please share your testimony: life before Christ, conversion experience, life with Christ.2. Sharing the Gospel is of utmost importance. What would you say to a 7 year old that asks you, “What is the Gospel?”3. In the event of a conflict or tension between you and another staff member, how would you approach the situation?

Reference InformationPlease list 3 professional or personal references, not related to you. (Employee, teacher, pastor, staff member at church, etc.)

In case of emergency, please list two contacts:

Do you have an active CPR/First Aid certification?NoYes

Have you ever been convicted of child abuse or neglect or any other crime?NoYes

Do you consent to a background check?NoYes

Thank you! Your submission has been received!

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