• Houghton RFKC New Counselor/Staff Application

    Houghton RFKC New Counselor/Staff Application

    All information will be held strictly confidential
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Date of Birth*
     - -
  • Gender*
  • T-Shirt Size*
  • Employment Information

  • Certifications

  • Do you have certification in any of the following?
  • Reasons for Applying

  • Previous Experience

  • Do you have any previous experience in working with children?*
  • Previous Experience

  • Do you have any training or experience in dealing with abused, neglected, or abandoned children?*
  • Background Information

  • Were you a victim of abuse, neglect or abandonmentas a minor?*
  • Working closely with 50 abused and neglected kids for an entire week could easily revive memories and feelings related to your own childhood background. If you have "worked through" painful memories of childhood, you could actually be a very insightful and effective counselor. If you have not, a camp like this could be overwhelming and impair your effectiveness in a counselor or staff role.

  • Medical Information

  • Do you have any medical problems?*
  • Do you take any medications?*
  • Have you had any serious illness in the last three years?*
  • Have you been inoculated for Mumps and Measles? (If you were born after 1956 you are required to have MMR inoculation.)*
  • Have you had a tetanus shot within the past 10 years?*
  • Emergency Contact

  • Format: (000) 000-0000.
  • Educational Background

  • Personal Profile

  • Church Information

  • Format: (000) 000-0000.
  • May we contact this person for a reference?
  • References

    List the names and contact information for 3 individuals—preferably not relatives—who have supervised you and can comment knowledgeably on your ability to work with children. Have each one complete the References Form by no later than February 15.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Working with Children

  • Personal Abilities and Characteristics

  • Rows
  • Additional Information

  • Background Information

  • Have you ever been arrested for a criminal offense?*
  • Have you ever been arrested for sexual molestation?*
  • Have you ever taken drugs other than prescribed drugs?*
  • Representations and Release

  • I hereby signify that all of the foregoing information is true and correct to the best of my knowledge. I also give consent to an authorized RFKC representative to use information contained in this application to conduct a criminal background check.

  • Do you agree to submit to a background check?*
  • Final Confirmation

  • Should be Empty: