Intern Application LBC

Internship Application

Please complete all questions.

PERSONAL INFORMATION
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Birth Date*

MonthDayYear
E-mail*
Home Number*

Area CodePhone Number
Cellular Number*

Area CodePhone Number
T-Shirt Size
Allergies*
What is the name of your Church? *
Have you been baptized in water?
Do you believe in the present day workings of the Holy Spirit?
Why are you interested in participating in this program?
Please give a description of your personal and spiritual salvation and growth, as well as your personal devotions. (200-300 words)

2 PERSONAL REFERENCES
Please provide 2 Personal References

One must be your Pastor
Please evaluate your personal spiritual growth and maturity, including a description of your person devotions. (200-300 words)
Personal Reference 1*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Relationship to Applicant*
Personal Reference 2*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Relationship to Applicant*

PROFESSIONAL REFERENCES
Please provide 2 Professional References
Professional Reference 1*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number

Area CodePhone Number
Relationship to Applicant*
Professional Reference 2*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Relationship to Applicant*

ELECTRONIC SIGNATURE CONSENT PAGE
Little Beaver Camp is a ministry of the Alaska Minsitry Network of the Assemblies of God (AKMN). In order to provide the safest possible environment in which our children and youth can experience God, all workers attending or assisting at any Alaska Ministry Network camps involving minors must be screened.

To complete this application to be a LBC Intern you must provide AKMN with an authorization to run a criminal records check. During this process, you will be asked to "sign" one or more of the online documents with an electronic signature. Please read the following carefully regarding the electronic signature process.

To sign a document electronically, fill out your name and your social security number in the fields required on the signature pages. If you do not agree to sign the document electronically, please terminate this application and contact Little Beaver Camp and Retreat Center for a digital copy of this application.

Once the signature process is completed, your electronic signature will be binding as if you had physically signed the document by hand.

If at any point you would like to withdraw your consent for your electronic signature, or if you need to update information needed to contact you electronically, please contact Alaska Ministry Network office at (907) 562-2247. Any withdrawal of consent will be effective as of the date it is received.

Check the box below to consent to provide an electronic signature rather than a handwritten signature in connection with your request for a background check about yourself and whenever you sign documents on this website.
I consent to the Electronic Signature*

YesNo
I understand that by typing my name, my social security number, and by accepting the terms, I am electronically signing the Authorization form directing a background check as described above.

I understand that my electronic signatures will be binding as though I had physically signed these documents by hand. I agree that a printout of this authorization may be accepted with the same authority as the original.
Full Name*

First NameLast Name
DATE

MonthDayYearHourMinutesAM/PM Option
Social Security Number*
I accept the terms of the Electronic Signature*

YesNo

AUTHORIZATION BACKGROUND CHECK
AUTHORIZATION AND REQUEST FOR CRIMINAL RECORDS VERIFICATION

I hereby authorize the Alaska District Council of the A/G, dba the Alaska Ministry Network to obtain and/or request information about my criminal history from any entity chosen specifically for conducting this search, to release information regarding any record of charges or convictions contained in its files, or in any criminal file maintained on me, whether said file is a local, state, or national file, and including but not limited to accusations and convictions for crimes committed against minors, to the fullest extent permitted by city, county, state, and federal law. I do release said entities from all liability that may result from any such disclosure made in response to this request. I may revoke this request at any time, but that revocation must be in writing and give 30 days’ notice of same.
DATE*

MonthDayYearHourMinutesAM/PM Option
Name as it appears on Driver's License*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Other Names used by Applicant (if any):
Birth Date*

MonthDayYear
Place of Birth*
Social Security Number*
Signature of Applicant*

Clear
Should be Empty:

Internship Application

Please provide 2 Personal References

Please provide 2 Professional References