GLC Support Staff Application
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  • Support Staff Application

  • Date of Application
     / /
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Date of Birth:*
     - -
  • What size staff t-shirt would you like?*
  • Are you physically capable of preforming the required job duties?*
  • Have you previously worked for Georgia Lions Camp?*
  • Were you previously employed under a different name?

  • Education

  • Did you graduate?
  • Did you graduate?
  • Were you in the military/?
  • Were you honorably discharged?

  • Work History

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

  • Reference Evaluation

    Two professional references are required.

  • Applicant Information

  • Format: (000) 000-0000.

  • Professional Reference #1

  • Format: (000) 000-0000.

  • Professional Reference #2

  • Format: (000) 000-0000.

  • Disclosure Statement

  • The Georgia Lions Camp promotes the safety of our campers as its highest priority. To facilitate this, all staff members are required to complete this Disclosure Statement indicating conviction of any sex crime and/or any other crime of violence against minors and an explanation of such charge(s).

  • Have you ever been accused, charged with, convicted, or received a deferred adjudication with respect to any felony or crime involving violence, sexual molestation, sexual abuse, sexual harassment, child abuse, or the distribution and/or trafficking of narcotics and/or controlled substances?*

  • Have you ever had a complaint filed against you or been convicted of any crime of violence, including but not limited to those listed below?

  • Indecent assault and battery on a child under 14 years of age*
  • Indecent assault and battery on a person 14 years or older*
  • Rape*
  • Rape of a child under 16 years of age with force*
  • Assault with intent to commit rape*
  • Kidnapping of a child under 16 years of age with intent to commit rape*
  • Distribution and trafficking of narcotics or other controlled substances*
  • Intent to commit any above crimes*
  • Any other crime or alleged molestation involving a minor*
  • Have you ever been adjudged liable for civil penalties or damages involving sexual or physical abuse to a domestic order or protection?*
  • Are you subject to any judgment involving sexual or physical abuse of a minor, but not limited to a domestic order or protection?*
  • Have your parental rights ever been terminated for reasons involving sexual or physical abuse of children?*
  • Date
     / /
  • Should be Empty: