Metropolis Summer Camp Medical Staff Application 20234
Greek Orthodox Metropolis of San Francisco
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Dear Prospective Metropolis Summer Camp Medical Staff,
Thank you for your interest in becoming a part of our Medical Team for the 2023 Metropolis Summer Camping Ministry at St. Nicholas Ranch and Retreat Center.

The 2024 Summer Camp dates are as follows:
Session 1: July 7 - 13
Session 2: July 14 - 20
Session 3: July 21 - 27

        
MEDICAL REQUIREMENTS:
-You must be a California licensed Medical professional (Doctor or Nurse) with current licenses and documentation available. You will be asked at a later date to submit record of your licenses.

Please complete your application forms online by May 1, 2024.

Thank you again for your desire to serve as a Metropolis of San Francisco Summer Camp Medical Staff Member. Please feel free to contact us with any questions or for additional information.

In Christ,

Johanna Duterte Carter
Director of Youth and Young Adult Ministries
Greek Orthodox Metropolis of San Francisco
Email: JDuterte@sanfran.goarch.org 


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Name *
First and Last
Date of Birth *
mm/dd/yyyy
Gender *
Current Medical Profession *
Home Address *
Street name, City, Zip
How long have you lived at your current address? *
Email address *
Cell phone *
e.g., 123-456-7890
Home phone
123-456-7890
Work phone
123-456-7890
Parish
Name and City
Parish Priest
Please list your addresses in the past five years *
Street Name and Number, City, State, Zip
T-Shirt Size
Clear selection
Position Information
Please confirm which medical position you are applying for *
For which weeks are you applying for? *
Required
Please provide your Curricula Vita information *
History of medical licenses and schools
What interests you about the position for which you are currently applying? *
Do you have previous medical experience at other camps?
Have you had any judgements against you for malpractice? *
Have you ever been accused of physically, sexually or emotionally abusing a child or an adult? *
Have you ever been convicted of any crime relating in any manner to children and/or your conduct with them? If yes, explain. *
Employment History
Please complete for your prior employers, covering the past TEN years. Use the following format: Company Name: Address: City, State, Zip: Immediate supervisor name and phone number: Position held: Dates of employment: Reason for leaving position:
Current Employer
Previous Employers
Volunteer Experience
Include all experience working with children or youth. Use this format in your answer: Organization: Contact: Phone: Duties: Dates
Volunteer Experiences
Educational History
Begin with the highest degree first
Name of School
Address
Street number, City, State, Zip
Type of School
Name of program or degree
Program completed? Yes or No.
Date completed or expected to be completed
Additional Schools?
Professional Reference
Name *
Phone Number *
Email Address *
How long have your known this person? *
CODE OF CONDUCT FOR THE PROTECTION OF CHILDREN AND YOUTH
Read and initial each item to signify your agreement to comply with this Code of Conduct.

To the best of my knowledge, the information contained in this application is complete and accurate. I understand that providing false information is grounds for not hiring me or choosing me for a volunteer position or for my discharge if I have already been hired or chosen. I authorize any person or organization, whether or not identified in this application, to provide any information concerning my previous employment, education, credit history, driving record, criminal conviction record, sexual offender registry or other qualifications for my employment or volunteering. I also authorize the METROPOLIS SUMMER CAMP to request and receive such information.

If hired or chosen, I agree to be bound by METROPOLIS SUMMER CAMP policies and procedures, including but not limited to the Greek Orthodox Archdiocese Youth protection and Procedures for Event Staff. I understand that these may be changed, withdrawn, added to or interpreted at any time at METROPOLIS SUMMER CAMP sole discretion and whithout prior notice to me. I also understand that my employment or volunteering may be terminated, or any offer or acceptance of employment or volunteering withdrawn, at any time, with or without cause, and with or without prior notice at the option of METROPOLIS SUMMER CAMP or myself.

Nothing contained in this application or in any pre-employment or pre-volunteering communication is intended to or creates a contact between myself and METROPOLIS SUMMER CAMP for either employment, volunteering or the providing of any benefit.
I have read and understand the above provisions *
First and Last Name
I agree to do my best to prevent abuse of children and youth involved in the Metropolis Summer Camp. *
I agree not to physically, sexually or emotionally abuse or neglect a child or youth. *
I have received and reviewed a copy of, and agree to comply with the Greek Orthodox Archdiocese Youth Protection Manual Policies and Procedures for Event Staff (the “Policy”) developed by the Greek Orthodox Archdiocese of America in cooperation with Praesidium, Inc. *
In the event that I observe any inappropriate behaviors or possible policy violations with children or youth, I agree to immediately report my observations to my supervisor and/or to appropriate state authorities as may be required by law, and as otherwise may be required under the Policy. *
I specifically acknowledge my obligation and responsibility to protect children and youth and agree to report known or suspected abuse of children or youth to appropriate church leaders and state authorities in accordance with the Policy and applicable law. *
I understand that the church or Metropolis will not tolerate abuse of children and youth and I agree to comply in spirit and in action with this position. *
I understand that I am an at-will employee or volunteer and can be removed from my position at any time and for any reason, or no reason, in the sole discretion of the [name of Camp/Retreat Program]. In addition, and without limiting the above, a. The [name of Camp/Retreat program] (the “Program”) may, in its sole discretion, deny the application of any person who answers yes to the following question: “Have you ever been accused of physically, sexually or emotionally abusing a child or an adult?” If I am selected, and the Program later discovers circumstances that would indicate a “yes” answer to the above question, I may be terminated immediately. b. The information provided on this form is subject to verification, which may include, but not be limited to, a criminal history check and request for information from any Central Registry of child abusers. c. The Program may, in its sole discretion, terminate employment or volunteer service of any person if that person is found, regardless of when discovered, to i. have been the subject of any complaint(s) of abuse of a minor, whether or not criminally charged or the subject of a civil suit; ii. have resigned, been terminated or been asked to resign a position whether paid or unpaid, due to complaint(s) of sexual abuse of a minor; and/or iii. have falsified or omitted information in this disclosure statement *
Please sign your name and date to indicate your understanding and agreement with the Code of Conduct stated above. *
First and Last Name, Date mm/dd/yyyy
Understanding Social Networking and Digital Communication
As a youth worker for the Greek Orthodox Archdiocese of America, you accept a great responsibility for nurturing the lives of young people, extending far beyond your interaction with them at a Direct Archdiocesan District/Metropolis camp or event (hereafter referred to as “event”). Young people will look to you as an example of Christian living, and may model many of their decisions based on what they see (or perceive) you doing, both on or offline. A youth worker will forever be recognized by young people, parents, clergy, and fellow staff members as a representative of the Church. For this reason, you should carefully consider the content and nature of any type of communication with a young person.

For the purpose of this Social Networking and Digital Communication Policy, content is defined as photos, videos, messages, posts, or any other information shared through social networking sites. In addition, this policy applies to any and all forms of digital communication, including but not limited to email, instant messages, texts, MMS, video chat, etc. One must also consider that any digital communication or content posted online, without its proper and original context, could be misconstrued, ultimately damaging the participants of this event and the Greek Orthodox Archdiocese of America.

For your own protection and the protection of young people, youth workers are strongly discouraged from any form of digital communication with a minor, including being “friends” on a social networking site. In order to facilitate continued mentoring and dialogue online, it is recommended that event administration create “official” social networking groups or fan pages. This allows for healthy communication with young people in an open forum, rather than private communication with a young person.

The Greek Orthodox Archdiocese of America requires that staff observe the following policies:
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Social Networking and Digital Communication Policy
FRIENDS & CONNECTIONS:
Youth workers are prohibited from initially contacting or requesting “friends” under the age of 18. Because you are in a position of authority as a youth worker, a young person may feel obligated to “accept” your friend request.

If a young person requests your “friendship” on a social networking site, or if you are already “friends” with minors, you are strongly encouraged to set stringent privacy settings in order to maintain appropriate boundaries.

APPROPRIATE CONTENT AND BEHAVIOR:
Any interactions with a young person through digital communication should be appropriate and professional and serve as a reflection of these policies.

Any inappropriate content on your profile/site or “tagged” to your profile/site must be removed. This applies to anything and everything on your profile/site, including both event and non-event content, i.e. personal photos, event orientation or break, etc. If another individual posts inappropriate content on your profile/site, you should immediately remove it and notify them to refrain from posting inappropriate content in the future. You should monitor your own profile/site regularly to make sure that you are reasonably aware, at all times, of its content.

Youth workers must not use blogs, personal pages or websites to disparage the event, its staff, employees, other individuals, or the Greek Orthodox Archdiocese of America.

Youth workers must not use social networking sites to share content prohibited by the event or Greek Orthodox Archdiocese of America policies, and not consistent with an Orthodox Christian lifestyle. This includes the abuse of alcohol and drugs, sexual behavior, sexual harassment, bullying, or use of obscenities, profanity, or vulgar language.

REPORTING PROCEDURE:
If you receive any inappropriate digital communication or content from a young person, you must immediately notify your direct supervisor, i.e. Event Director, Metropolis Youth Director, Metropolis Chancellor, etc.

If a young person reveals abuse or inappropriate interactions of any kind with an adult, you must immediately notify your direct supervisor, i.e. Event Director, Metropolis Youth Director, Metropolis Chancellor, etc.

If you have additional questions about reporting procedures, please refer to the “Reporting” section of the Policies and Procedures for Event Staff.

Any youth worker found to be in violation of any portion of this policy will be subject to immediate disciplinary action, and may include the youth worker’s immediate dismissal from the staff and exclusion from future programs, events and activities at the discretion of your direct supervisor, i.e. Event Director, Metropolis Youth Director, Metropolis Chancellor, etc.
Clear selection
Please sign and date to indicate that you have read and understood these policies. *
First and Last Name, Date mm/dd/yyyy
Acknowledgment, Release and Signature
To the best of my knowledge, the information contained in this application is complete and accurate. I understand that providing false information is grounds for not hiring me or choosing me for a volunteer position or for my discharge if I have already been hired or chosen. I authorize any person or organization, whether or not identified in this application, to provide any information concerning my previous employment, education, credit history, driving record, criminal conviction record, sexual offender registry or other qualifications for my employment or volunteering. I also authorize [Name of Camp/Retreat] to request and receive such information. If hired or chosen, I agree to be bound by [Name of Camp/Retreat] policies and procedures, including but not limited to the Greek Orthodox Archdiocese Youth Protection Manual Policies and Procedures for Event Staff. I understand that these may be changed, withdrawn, added to or interpreted at any time at [Name of Camp/Retreat Program] sole discretion and without prior notice to me. I also understand that my employment or volunteering may be terminated, or any offer or acceptance of employment or volunteering withdrawn, at any time, with or without cause, and with or without prior notice at the option of [Name of Camp/Retreat] or myself. Nothing contained in this application or in any pre-employment or pre-volunteering communication is intended to or creates a contract between myself and [Name of Camp/Retreat] for either employment, volunteering or the providing of any benefit. I HAVE READ AND UNDERSTAND THE ABOVE PROVISIONS. *your electronic signature IS legally binding
Signature *
First and Last Name
Signature Date *
mm/dd/yyyy
Thank you for applying for our Metropolis Summer Camp program at St Nicholas Ranch!  
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