2023 New Life Summer Camp - Staff Application

2023 New Life Summer Camp - Staff Application
First Name*
Last Name*
Birth Date*

MonthDayYear
Place of birth*
Age at date of camp*
Gender*

MaleFemale
Address*
City*
State*
Zip Code*
Phone*
Cell Phone*
Email*
Social Security #*
Driver's License#*
State issued*
Church Name:*
Church Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Church E-mail*
Pastor Name*

First NameLast Name
Pastor Phone Number*

Area CodePhone Number
Pastor E-mail*
Marital Status*

MarriedSingleDivorce
Emergency Contact Name*
Required for Background Check:
1. Have you ever been convicted of a crime of sexual abuse, sexual harassment or exploitation?*

noyes
2. Has any civil or criminal complaint, or any other written complaint ever been made against you relating to sexual abuse, physical abuse,sexual harassment or exploitation*

noyes
3. Have you ever terminated your employment or had your employment terminated for reasons relating to allegations of civil or criminal complaints or sexual abuse, physical abuse, sexual harassment or sexual harassment or exploitation against you?*

noyes
4. Have you ever received any medical or psychological treatment, including counselling, involving your sexual abuse, physical abuse, sexual harassment or sexual exploitation of other persons?*

noyes
5. Did you enter into an agreement with any past employer not to divulge the true reason for termination of employment?*

noyes
I hereby acknowledge that I have received a copy of the sexual misconduct policy and that I understand its meaning and agree to conduct myself in accordance with the policy. I have personally read and completed the above background questions.

I understand that if a background check reveals a prior sexual misconduct-related offense, that I will be permanently ineligible to volunteer to perform social services, counseling, or in any other way be involved in the care, supervision and/or teaching of minors, including nursery, day care, school, athletic and/or overnight activities involving minors, or mentorship of minors. or involved in our camping programs
Signature*

Clear
Weight*
Height*
Eye Color:*
Hair Color:*
Personal Insurance Company (Please enter NA if no Insurance)*
Insurance Policy Number (Please enter NA if no Insurance)*
I Understand That the Local church Insurance policy, will provide secondary medical coverage , My insurance is primary. I accept any and all medical costs in case of an accident or a serious illness; you have my permission to secure the proper medical treatment. I understand that I will not hold Camp Elkanah, New Life Summer Camp, or The Church of God liable while involved in the Camp.
Local church insurance company:*
Policy number:*
Please Check:*

I UnderstandI Agree
General Medical Information*
Do you have any Health problems or physical limitations*

noyes
List any physical handicaps you may have*
Gluten Free Diet?*
Any Medications? Their purpose*
Have you ever been convicted of or pleaded guilty to a felony?*

yesno
Allergy Information*
Have you ever been charged with or pleaded guilty to an assault, sexual abuse or child abuse?*

yesno
Spiritual Status*

SavedSanctifiedHoly Spirit BaptismBaptism in waterMember of your Church
Your Hobbies*
Church Activities*
Occupation*
Previous Youth camp Experience*
All staff will receive a free t-shirt if registered and accepted by June 1st.*

Adult SmallAdult MediumAdult LargeAdult X LargeAdult XX LargeAdult XXX Large
Position Desired*

CounselorCanteenTeachingRecreationFood Service (Kitchen)NursingMaintenanceMediaSecurityOther
It is mandatory that you attend!

The Pre-Camp Training Session Monday (8/01/2022)

(Campers must not arrive on Monday earlier than 1:pm.)

I certify that all of the above information is true. I agree to comply with and abide by any and all rules and regulations of the New Life Summer Camp as set forth by the New Life Summer Camp Camp Director and staff. I further agree to any and all background checks which shall be deemed necessary by the New Life Summer Camp . I will attend the mandatory Pre-Camp Training Session on Monday (8/01/2022)
Please Check*

I AgreeI Undestand
Your Local Church's Lead Pastor Recommendation Required

I certify that I know the above applicant and he/she is a capable and qualified person to work in the New Life Summer Camp. I give them my highest recommendation to serve with youth/children in any capacity deemed necessary by the Camp Director.

(Required to be accepted)
Please Check*

I AgreeI Disagree
Statement of Reservation

While no one is rejected to work or attend New Life Summer Camp on the basis of gender or race, The New Life Summer Camp Director does reserve the right to accept or reject any application for volunteer work at New Life Summer Camp after review of said application reveals that the services of the applicant would not be needed or are not in the best interest and success of the camp.
Please Check*

I AgreeI Undestand
All staff are ask to pay ($15.00 ) per night to keep the cost of the camp rental low for the campers*

Personal checkChurch checkother
Church you're arriving with?*
Only Confirmed Staff Should arrive For Orientation/Camp---

Bring confirmation Letter. Return application as soon as possible!
*
Signature: Please Sign with your mouse on the line*

Clear
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