www.evo-pgh.org
4740 Friendship Ave Pittsburgh, PA 15224
(O) 412.681.7272
(F) 412.681.0239
I am applying for (circle one)
Summer Camp Intern 6 month Intern Year Long Intern
First Name ______Middle ______
Last Name______
Permanent Street Address (use this address after ____/_____/201__
______
City______State______ZIP______
Home Phone______Cell ______
Email Address ______
Social Security Number ______
Are you at least 21 years old?______
Highest level of education ______
If Student, University/College Currently Attending ______
College Major ______
Years Completed ______College Phone______
College Mailing Address (use this address until ______/_____/201__
______
City ______State ______ZIP ______
Church Membership ______
Pastor's Name______Pastor's Phone______
Please list present and/or recent work experience:
Employer: ______
Supervisor’s Name: ______
Supervisor’s Phone Number: ______
Dates of Employment ______
Job Title ______
Responsibilities:
______
Employer: ______
Supervisor’s Name: ______
Supervisor’s Phone Number: ______
Dates of Employment ______
Job Title ______
Responsibilities:
______
Have you ever been convicted of a felony?______Please explain. ______Such a conviction may be relevant if job-related, but does not necessarily bar you from employment.
Have you ever been accused or convicted of any form of child abuse? ______If yes, please describe on a separate sheet.
Do you have Act 33 and 34 Criminal Record Check and Child Abuse clearances? ______If not, are you willing? ______
References
Reference #1 - Professor or Employer ______
Phone ______Email ______
Reference #2 – Friend ______
Phone ______Email ______
Reference #3 – Pastor/Mentor______
Phone ______Email ______
Please indicate your degree of competence or interest in the following areas. (You may mark as many areas and levels as you wish. Please add any other areas in which you are gifted.)
Description:
-0- I have no skill in this area at all
-1- I’ve dabbled in this area once or twice before
-2- I’m a capable backup to someone else
-3- I’m fairly skilled in this area
-4- I’ve had a good deal of experience
______Helping Urban Young People Grow Spiritually
______Lead in song or through playing an instrument
______Designing and Teaching Bible
______Lessons for Urban Young People
______Tutoring Urban Young People & Assisting Them Academically
______Leading Group Games and Activities
______Facilitating Conflict Management
______Leading Arts and Crafts Activities
______Planning Special Events
______Musical Abilities (______)
______Playing or Coaching a Sport (______)
Other: ______
Please write or type answers to the following questions and submit them on a separate sheet. Five to eight sentences should be an approximate range for each answer.
1. Describe a recent experience with kids or youth. What tasks did you enjoy? What tasks did you least enjoy? Why?
2. What would you hope to contribute (give) as a teacher in one of Earthen Vessels Outreach children’s programs?
3. How would you hope to grow (take in) as a member in one of Earthen Vessels Outreach children’s programs?
4. If you are a student, what is your major area of study, and what do you hope to do professionally in the future?
5. Please describe your relationship with Jesus Christ.
6. What is one Bible passage that is significant to you, and why?
7. Please describe your reasons for wanting to work with urban young people.
8. Please describe your personal strengths and weaknesses, as you perceive them.
9. Are you currently involved in a church community? If yes, please describe your involvement.
If no, are you interested in becoming involved?
10. A summer internship involves living in Christian community. You work with those you live with. Return daily to plan and cook meals together. Fellowship, worship and study the Bible together on a daily basis. What can you gain, give and grow from this experience? How will it challenge you?
11. What are your interests and free time activities?
12. Please describe any other experiences that you feel have helped to prepare you for a position as teacher in one of Earthen Vessels Outreach children’s programs.
I hereby attest that the information in this application is true. I also give permission to Earthen Vessels Outreach staff to contact the references or employers listed. I understand that the personal information in this application will be held confidential by the designated staff of Earthen Vessels Outreach.
______
Signature Date
Return To:
Marilyn Chaney
Cell: 412.414.2993
Email:
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