New Counselor or Staff Application
All new applicants are required to complete this application form.  You must be at least 21 years of age to apply.  This information will be used to help MCLC coordinators provide a safe and secure environment for those students who are participating in our camp.  The material contained in this application will be shared only with our camp board or as required by law.  Please put "N/A" in any field that does not apply to you.   
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Your full legal name *
Current physical street address *
Current City, State, Zip Code *
Number of Years at Current address *
Your email *
Best Phone Number (888-888-8888) *
Adult Shirt Size *
Marital Status *
Date of Birth (00/00/0000) *
Drivers License Number and state of Registration *
Ministry Experience - Church where you have served, ministries you have served in, City, Capacity, etc. *
Please briefly describe your Testimony and Christian Walk. *
Personal Lifestyle - We expect our counselors to be above reproach and a living example to our campers.  Is there anyting in your personal life that would cause another person to stumble in their faith? *
If the above answer was yes, please explain
Have you ever been convicted of any offense against the law other than traffic tickets? *
If the above answer was yes, please explain
Have you ever been accused, charged, or alleged to have committed any act of neglecting, abusing, or molesting a child? *
If the above answer was yes, please explain
Have you ever been asked to leave a church or otherwise terminate your voluntary service to any ministry or program? *
If the above answer was yes, please explain
Do you have any physical or mental impairments or spiritual weaknesses that might limit or restrict your ability to serve as a counselor? *
If the above answer was yes, please explain
I have read and declare the information provided on this application to be true, complete and correct to the best of my knowledge.  I agree to wholeheartedly enter into the spirit of the camp and participate in the total camp program.  I will fulfill my responsibility as part of the MCLC team and will follow all camp rules and policies.  By clicking yes below, I give authorization to MCLC to verify the information in this form.  They may contact my references and appropriate government agencis as deemed necessary in order to verify my suitability to work with youth at Midsouth Christian Leadership Camp.   *
Please enter a ministry reference.  Not a family member.  (First and last name, position at what location, i.e Frank Smith, youth pastor, Calvary Baptist Church) *
Reference Phone number  *
Reference Email *
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