Program Personnel Application Form

Program Personnel Application Form
Instructions: This application must be completed by anyone wishing to be involved in the supervision or instruction of minors (persons under the age of 18) under the authority of Moose Lake Gospel Camp, whether paid or volunteer. In order for MLGC to provide a secure environment both for the children it ministers to and also the leaders that minister, the following questions must be answered honestly and completely.

The MLGC Board Members/ Directors will keep all information strictly confidential. (Police may access this information, if requested.) Any questions of a sensitive or personal nature may be discussed with the MLGC Board/ Director upon completion and may not necessarily preclude your involvement in children’s ministry.
Name*

First NameLast Name
Name of Parent or Guardian if under 18
Male or Female?*

MaleFemale
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com

Confidential Information
Do you have a criminal record or have you ever been convicted of a criminal offence?*

YesNo
Have you used illegal drugs?*

YesNo
Do you have or have you ever had any psychiatric health problems?*

YesNo
If you answered yes to any of the above questions, please explain:
I agree to provide a Vulnerable Sector Check (VSC) prior to my first day of work. Note: This VSC must be a new one from 2025*

I agree
Vulnerable Sector Check (if available)

Cancelof

Character References
Christian Character Reference #1*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Character Reference #1 Email*
example@example.com
How long have you known this reference? In what capacity/relationship?*
Christian Character Reference #2*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
How long have you known this reference? In what capacity/relationship?*
I give Moose Lake Gospel Camp permission to contact the people I have listed as references to determine my suitability for ministry.*

I accept

Liability and Health Release
You release Moose Lake Gospel Camp, its staff, volunteers, and board members from all manner of actions, claims, and demands of whatever nature resulting from any loss, injury, or expense sustained, during your attendance at Moose Lake Gospel Camp.*

I agree

Media Consent & Release
I authorize Moose Lake Gospel Camp to take images or video footage of me, in whole or in part for various purposes. I waive any right to compensation, promotional material, and legal actions resulting from any media materials collected.*

I acceptI do not accept

Commitment
Should my application be accepted, I agree to be bound by the Moose Lake Gospel Camp disciplinary processes if I am to break any MLGC policy or rule while serving at Moose Lake Gospel Camp*

I agree
I agree that all the information given in the application is accurate and true. *

I agree
By checking this box you are giving your electronic signature for all information collected on this application form.*

I agree
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