New Staff Application - For the Children Fargo

Mentor/Staff Application

Sponsored by River City Church
Royal FamilyKIDS
For Questions / Concerns Contact:

email: ftcfargo@gmail.com

phone(text/call): 605-770-7731
Instructions: All information is held securely and is strictly confidential. This form must be completely filled out. The information is vital to your acceptance and possible placement as a volunteer.
Date*

MonthDayYear
Date
Last 4 Digits of Social Security Number*
Full SSN may be required seperately to obtain the criminal background check from a third party.
Please upload a Headshot of yourself: *

Cancelof
A photo I.D. (preferably Drivers license, Passport etc will be required to be shown at the interview to verify that your photo and name match the name on this application and background check.
Name*

First NameLast Name
Birthdate*

MonthDayYear
Date
Gender*

MaleFemale
Street*
City*
State*
Zip*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Marital Status*
Occupation*
Name of Employer*
Number of years at employer*
How long have you lived in [ND / MN] Years* years and months* months.
If you lived in ND/MN less than five years, please list your complete addresses for the last five years.
T-Shirt size:*

Adult SmallAdult MediumAdult LargeAdult X-LargeAdult XX-Large
Do you have certification in the following:

CPRFirst AidLife GuardNurseEMT
Do you have previous training or background in dealing with abused, neglected or abandoned children?*

YesNo
If yes, in what way?
Were you a victim of abuse, neglect or abandonment as a minor?*

NoYesYes, but I would prefer to discuss this in person.
Please Clarify. If you'd prefer to discuss in person, please skip this section.
Please describe why you wish to be a volunteer for RFK?*
Emergency Contact Information
Emergency Contact Name*
Relationship*
Phone Number*
Please enter a valid phone number.
MEDICAL CONCERNS
Camp can be physically tiring, even exhausting. The facility or activities may require volunteers to manage uneven terrain, require hiking. climbing, running, swimming. lifting. stairs, and other strenuous activities depending on the volunteer position.

Your medical condition (physical fitness, recent or chronic injuries, allergies, physical or emotional limitations, etc and even the medications you take may be affected by the activities, the altitude, the foods served, the emotional challenges with the kids, or the sleeping conditions.

(Note: Volunteers who stay in the sleeping quarters with the children are not allowed to have medications in those quarters. Medications may be kept in other secure locations as designated by Camp Leadership. )
Do you have any medical conditions or concerns, or are you taking any medications that you believe could prevent you from being an effective volunteer that we need to know about in order to help you be effective at camp?*
RECORD OF EDUCATION
High School Name
Date of Graduation

MonthDayYear
Date
College
Major
Date of Graduation

MonthDayYear
Date
Other
Major
Date of Graduation

MonthDayYear
Date
PERSONAL REFERENCES (not relatives)
Contact #1 Name*
Contact #1 Email Address*
Contact #1 Phone*
Please enter a valid phone number.
Contact #2 Name*
Contact #2 Email Address*
Contact #2 Phone*
Please enter a valid phone number.
Contact #3 Name*
Contact #3 Email Address*
Contact #3 Phone*
PERSONAL & FAITH PROFILE
Have you committed your life to Jesus Christ:*

NoYes
If yes, when and where?
What church do you presently attend?*
Pastor's Name*
Church Phone #*
Have you served at a Royal Family Kids Camp or Mentoring Club before?*

NoYes
If yes, please list the following (when, where, & director's contact information)
Do you have any previous experience working with children?*

NoYes
If yes, please describe:
Do you have any previous experience working with foster children or children in trauma?*

NoYes
If yes, please describe:
Do you feel you could lead a 15-minute devotion with your campers with material we provide?*

YesNo
Please check all the words below which you believe accurately describe you:*

TimidTactfulCongenialSecureOrganizedGentleMatureCompassionateConsiderateImpulsiveImpatientSarcasticStubbornAbrasiveIntelligentModestPatientKindTrustworthyInsecureNervousAngryStudiousMotivatedRelaxedLovingDeliberateSelfishVerbal
List You 5 Greatest strengths for working with children:*
List You 5 Greatest weaknesses for working with children:*
I'd prefer working with these ages of campers:

6-8 years old8-10 years old11-12 years old
CRIMINAL BACKGROUND
If your records have been expunged pursuant to applicable law, you are not required to answer yes to the following questions. If you are unsure whether to answer yes, we strongly suggest that you answer yes and fully disclose all incidents to avoid any future risk of embarrassment upon disclosure.
1. Have you ever been convicted of or pleaded guilty to any crimes (including crimes of record which have been expunged and pleas of 'no contest'), including municipal, state and federal?*

YesNo
2. Have you ever been placed on probation, received a Suspended Execution, Suspended Sentence or Suspended Imposition of Sentence for any offense involving a minor child (a child under 18), or been placed on ANY local, state, or federal sexual registry?*

YesNo
3. Have you ever been sued in a civil court of law where the allegations in the suit involved illegal, inappropriate, or sexual conduct or contact with a minor child?*

YesNo
4. Have you ever been subject to any court order involving any sexual, physical or verbal abuse including but not limited to any domestic violence or civil harassment injunction or protective order?*

YesNo
5.Have you ever resigned, been terminated or been asked to resign from a position, whether paid or as a volunteer, due to a complaint(s) of sexual, physical or verbal abuse of minors?*

YesNo
I understand that for the church to carry on a RFK Camp, it has had to agree to abide by certain policies and parameters established by RFK, including strict policies against any form of child abuse, and that violation of these policies may be cause for dismissal. Child abuse is punishable by law, and the church is bound by law to report allegations of abuse or any inappropriate sexual contact to the proper authorities. ALL reporting is kept confidential, by law. All volunteers must commit to immediately report any behavior that seems suspicious, questionable, abusive or inappropriate between: child-to-child, staff-to-child, and staff-to-staff.

If YOU are struggling with a sexual attraction to children, please opt out of service in the church's RFK Camp or any other child-serving organization and seek help. One option is: *Hope for the Heart" at (800)488-HOPE (4673) or www.hopefortheheart.org.

I understand that I will be required to submit to a background check as a condition of acceptance as a volunteer, and that unsatisfactory results, refusal to cooperate, or any attempt to affect the results of these background checks will result in me being removed as a volunteer or volunteer applicant.

I hereby certify that all of the information provided by me in this Application (or in any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in these documents may (or will) be cause for the denial of acceptance as a volunteer, or immediate removal as a volunteer, regardless of the timing or circumstances of discovery.

In consideration of the receipt and evaluation of this Application by For the Children Fargo and River City Church, I hereby authorize you to contact any references, churches, youth groups, schools attended, former and present employers, charities, courts, and any other person, agency, or organization that may have information about me, and for them to provide to you such information (including opinions) that they may have regarding my character and fitness for working with children; I hereby release any such references, churches, youth groups, schools attended, former and present employers, charities, courts, and any other person, agency or organization who may have provided information about me, including record custodians, both collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs, or family, on account of compliance or any attempts to comply with this authorization. I also agree to hold RFK, the sponsoring church, RFK Camp Leadership, and any other person to whom the release above applies, harmless from any damages, specifically including attorney fees and court costs, created by or relating to my unwarranted attempt to collect damages for providing information described above or any other unwarranted action by me in connection withthis Application. I waive any right that I may have to inspect any information provided about me or by any person or organization identified by me in the Application process.
In addition, I hereby release, and agree that I, my successors, assignees, heirs, guardians and legal representatives will not make any claims or take any legal actions against, RFK, or any of its affiliated organizations, or its officers, directors, employees, agents, or volunteers ("Released Parties") for my injury, death, damage or loss, however cause, arising from or in connection with my participation in RFK activities, with the exception of my injury, death, damage or loss as the direct result of illegal or grossly negligent acts by RFK and I will hold the Released Parties harmless from any costs or loss, including attorney fees and court costs arising from or in connection wtih my activities in violation of these provisions.

I understand that submission of an application does not guarantee me acceptance as a volunteer. I further undertsand that should the church extend an offer to me as a volunteer, it is for no specific duration and may be revoked by either the sponsoring church, or me at any time, with or without cause.

I understand that none of the documents, policies , procedures , actions, statements of RFK, the sponsoring church, the RFK Leadership or their representatives and agents used during the volunteer application process is deemed an offer for a contract, real or implied. If accepted as a volunteer, I agree to conform to the rules regulations, policies, and procedures while serving as a volunteer, and understand that such compliance is a condition of remaining a volunteer.

All Royal Family KIDS Camps are operated as a ministry of River City Church or in conjunction with a local non-profit organization. As such, all volunteers will fall under the authority of the Camp Leadership as trained by the RFK National Office and under the authority and beliefs of the River City Church. All volunteers need to understand that church leadership has authority over the operations and expectations of the RFK Camp and the churches beliefs will inevitably be evident in the selection process and operation of the RFK Camp as a ministry of their church.
REPRESENTATIONS AND RELEASE
I have carefull read the above Application and this Acknowledgement and Release and know and understand its contents; I also know the above is legally binding on me. I sign this Application and Release of my own free will.
Signature*

Clear
Name printed*
Date executed*

MonthDayYear
Date
Should be Empty:

Mentor/Staff Application

Royal FamilyKIDS

Emergency Contact Information

MEDICAL CONCERNS

RECORD OF EDUCATION

PERSONAL & FAITH PROFILE

CRIMINAL BACKGROUND

REPRESENTATIONS AND RELEASE