Staff Application

All information is held strictly confidential. This form must be completely filled out and include a scanned copy of your photo ID (not a picture - we recommend the app ScanGenius). You must also complete the DHS Clearance Form before being fully applied. There is a section and link for the DHS Form below. The information is vital to your acceptance and possible placement as a staff member.

Name*

First NameLast Name

Name for Name Tag*

Mr/MissFirst Name

Birthdate*

Date

Age*

Email*

example@example.com

Which team are you applying for?*

West Camp: June 9-13 (based in Holland, MI)Central Camp: August 10-15 (based in Frankenmuth, MI)East Camp: August 17-22 (based in Oxford, MI)

Cell Phone Number*

Please enter a valid phone number.

Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Marital Status*

Are you retired?*

YesNo

Job Information:*

Social Security*

Current Driver's License #*

Emergency Contact:*

Race:*

If you chose other, please explain here:

T-Shirt Size*

What position are you interested in applying for? (Check all that you are interested in!)*

If chosen as a Camp Counselor, I would prefer my campers' ages to be:

Please check any of the following certifications you currently have:*

Do you have previous training/background/experience in working with abused, neglected, or abandoned children?*

YesNo

If yes, please explain:

Have you been a victim of abuse, neglect, or abandonment?*

NoYesYes, but I would prefer to discuss in person.

Please clarify:

Please describe why you wish to be a volunteer for children that have suffered from abuse, abandonment, and neglect:*

Do you have any medical conditions?*

YesNo

If yes, please describe:

Do you take any medications?*

YesNo

Medications

Have you had any serious illness or injuries in the last three years?*

YesNo

If yes, please list below:

Do you have any physical handicaps or conditions preventing you from performing any type of activity?*

YesNo

If yes, please list below:

Highest Level of Education*

Major(s) and Minor(s)

Reference #1*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Reference #2*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Reference #3*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Who or what led you to Love For A Child Kids Camp?*

Why is it on your heart to be part of this experience?*

How are you hoping God will use you this week and is there anything Love For A Child can join you in prayer on?*

When working with children what do you believe are some of your best qualities and what are some areas you feel you could grow in?*

If given materials, do you feel like you could lead a 15-minute devotion with your campers?*

YesNo

Are you currently attending a church?*

YesNoYes, but not regularly

If yes, what is the name of your church?

Have you ever been arrested for a criminal offense?*

YesNo

Have you ever been convicted of, or plead guilty, to a crime?*

YesNo

Have you ever been arrested for sexual misconduct?*

YesNo

Have you ever been convicted of, or plead guilty, to sexual misconduct?*

YesNo

Have you ever taken drugs other than prescription drugs?*

YesNo

Do you currently use tobacco?*

YesNo

Do you currently use alcohol?*

YesNo

Do you currently use drugs?*

YesNo

If you selected yes on any of the above, please explain:

Do you have any food allergies?*

YesNo

Food Allergies:

If you answered "Other", please explain:

Applicant's Statement:

The information obtained in this application is correct to the best of my knowledge. I authorize any references listed in this application to give you any information (including opinions) that they may have regarding my character and fitness for children or youth work. In consideration of the receipt and evaluation of this application by Love For A Child, I hereby release any individual, church, youth organization, charity, employer reference, or any other person or organization, 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 waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application. Signing this application agrees to allowing Love For A Child to use (photo/video) media documentation for sharing and marketing purposes publicly.

I further state that I have carefully read the foregoing release and know the contents thereof and I sign this release as my own free act. This is a legally binding agreement which I have read and understand.

Please be advised that a criminal history check will be requested from the state(s) of Michigan as authorized by state law.

Print Name*

Signature*

Today's Date*

Date

Any other comments or questions about camp or anything:

Please check the box to indicate that you have read the following lifestyle agreement and conditions and confirm that you agree to the mission, understanding, and expectations as serving as a volunteer for Love For A Child.*

I have read the statements above and agree.

Please Sign below stating that you have read and agree to the Lifestyle Agreement.*

Please fill out this quick DHS Background Clearance Form before hitting submit on this form. There will be a code given to you on the "Thank You" page you will need to enter below before you can submit your volunteer application. Follow the link below and then enter the code below signifying you have completed and submitted the DHS form.

DHS Background Check Clearance

Enter the 4-Digit Code From the DHS 'Thank You' Page:*

If the correct code is not entered, you will be unable to submit this form.

Staff Application

Education Background

PERSONAL REFERENCES