2022 counselor application form
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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 Counselor
Part Time/Substitute Counselor
Junior Counselor (Volunteer)
Work Shift applied for (Full Time Counselors only):
7:30 - 4:30
8:30 - 5:30
Age Group applied for (Full time Counselors only):
Kindergarten-2nd Grade
3rd-5th Grade
Middle School
Education Information
Name of Highschool:
Name of College/Technical:
Work Experience
Please 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 possible
1. 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 Information
Please 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?
No
Yes
Have you ever been convicted of child abuse or neglect or any other crime?
No
Yes
Do you consent to a background check?
No
Yes
Thank you! Your submission has been received!
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address:
2601 Hillsborough Road
Durham, NC 27705
office phone:
919.286.2281
(M-F 8am - 5pm)
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