GROVE CHRISTIAN SERVICE CAMP

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CONFIDENTIAL Camp Staff Information

Thanks for considering Grove Christian Camp!

This form is to be completed by all applicants for any position (volunteer or compensated) involving the teaching, supervision or custody of minors. It is being used to help the camp provide a safe, secure and spiritual environment for the youth who participate in our program. Because of the sensitive nature of some questions, only the camp directors and executive committee will be given access to this form for the sole purpose of selecting our camp staff members.

Name: *

Age: *

Birthdate: *

YYYY

Gender: *

Male

Female

Address: *

Phone Number: *

Mailing address if different: *

Social Security Number: *

Marital Status *

Single

Married

Engaged

Divorced

Are you an immersed believer: *

Yes

When did you become a Christian? *

YYYY

Name of Church where you are a member: *

Address of Church where you are a member: *

Phone number of Church where you are a member: *

How long have you attended there? *

Pastor's name: *

List other Churches you have been a part of in the last 5 years: *

Do you have a background check on file at your current church?

Yes

Clear selection

Do you have any physical handicaps or conditions that prevent you from performing certain types of activities? *

Yes

Have you been the victim of abuse?

Yes

Clear selection

Are you having difficulties in dealing with previous abuse that could affect your working with children and their welfare?

Yes

Clear selection

Have you ever been criminally charged, investigated for or civilly sued for any of the following offenses? *

Rape

Sodomy

Sexual Abuse

contributing to the delinquency of a minor

sexual misconduct

public indecency

None of the above

Other:

Required

If so, please explain: *

Which camp age groups are you interested in working with? *

List other experiences, training, education and factors that you feel have helped you become prepared to serve at camp: *

List the name, address and phone number of a church minister or a leader with whom you have worked: *

List the name, address and phone number of a church minister or leader with whom you have worked: with name, address and phone. *

Applicant’s Statement

This information contained in this application is correct to the best of my knowledge. I authorize any references of churches listed in application to release any information they may have regarding my character and fitness for work in a camp setting. I release all such references from liability for any damage that may result from furnishing such evaluations to the camp. I also state I will study and abide by the Policy Booklet and Camp Goal statement of Grove Christian Service Camp. I agree to work in whole hearted cooperation with the staff under the authority of the directors and camp manager. I agree to maintain a Christ like spirit and a watchful eye toward the safety and needs of all campers. I agree to attend the
staff training sessions and/or meet with the camp directors. I give consent for Grove Christian Service Camp to obtain a background check .

Name *

Date: *

YYYY

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