Online Staff Applications - Welcome to the Tri-State Fellowship Camp

Tri-State Fellowship Camp Staff Application
Completion of this application is necessary to ensure the safety of our children and youth.As servants of Christ, we regard the care of children as a great responsibility.
Applications due no later than April 30th 2010
Staff Application for 2010 "Glow in the Dark"
Staff training arrival: Sat. July 10h Check-in: 1:00 P.M.
Staff departure: Fri. July 16th Check-out: TBD, by the Director after clean up is complete.
*Staff Discount is 50% off the early bird Registration for staffer's children*
A total of $35.00 needs to be included with your application for the following. A NONREFUNDABLE fee of $10.00 to be used to run a background check. A refundable training fee of $25.00 must also be included with your application. This fee will be refunded if for any reason your application is not selected
Make Checks payable to "Tri-State Fellowship Camp" and mail to:
Tri-State Fellowship Camp
Camp Director: Ron Sheranko
c/o First Grace Brethren Church
2624 Stonequarry Rd.
Dayton, OH 45414
Please specify what camp you are applying for. *
Campers will arrive to camp Sunday July 12th at 2:00 P.M.
Application Information:
Are you available for the entire week of camp (see dates above)? *
What position at camp are you applying for? *
Desired Position:
Are you willing to work a diffrent position id needed?
Personal Information:
Full Name: *
Address: *
Birth Date: *
Age as of camp:
Previous Address: *
Home Phone: *
Alternate Phone:
Social Secuity #:
I you do not want to give your social security number online Please mail it to:
Tri-State Fellowship Camp
Camp Director: Ron Sheranko
c/o First Grace Brethren Church
2624 Stonequarry Rd.
Dayton, OH 45414
Please note however your application will not be considerd untill your background check has been completed and your social security number is needed to complete this function.
Emergency Contact:
Name: *
Phone: *
Secondary Name: *
Phone: *
The following questions are used to determine duty assignments:
Do you have a valid driver's license? *
State:
Driver Lic. #
You may mail this to the same address as the social security number.
Do you have a cuurent chauffeur-type license? *
Do you have a commercial Driver's license? *
Do you have access through your church or otherwise to a bus or large van? *
Do you have any medical training? *
Work History:
Please use the space provided to list employment history - paid and volunteer. Please explain any gaps in employment. Use a separate sheet if needed. *
Indicate any employer you do not with us to contact, and the reason. *
References: Give names of three persons (not relatives) having knowledge of your character, experience and work habits. Please list Name, Address and Phone number for each. *
Spiritual Information:
Describe Jesus Christ: *
Describe your relationship with Jesus Christ: *
Church Information:
Church which you attend regularly: *
Are you a member? *
Pastor's Name: *
Phone: *
How are you actively service your local church? *
Camping Information:
Please list any camp or experience working with children. *
What are your strengths with children?
What is your weakness in this area? *
Personal History:
Have you ever been accused or convicted of any crime relating in any maner to children, youth, or vulnerable adults and/or your conduct with them? *
If yes, Please explain:
Have you ever been accused or convicted of any crime involving children, youth or vulnerable adults? *
If yes, please explain:
Have you ever been adjudged liable for civil penalties or damages involving sexual or physical abuse of children, youth or vulnerable adults? *
If yes, please explain:
Are you now or have you ever been subject to any court order involving sexual or physical abuse of a minor, youth, or vulnerable adult, including, but not limited to a domestic order for protection? *
If yes, Please explain:
Have your parental rights ever been terminated for reasons involving mental, sexual or physical abuse of children? *
If yes, please explain:
Within the last 12 months have you deliberately exposed yourself to pornography? *
If yes, please explain:
Have you ever been accused or convicted of any crime of a sexual nature? *
If yes, please explain:
Is there any reason you should not work with children? *
If yes, please explain:
Have you been accused or convicted of a crime, other than a minor traffic violation, of any sort *
If yes, please explain:
Medical Information:
Do you have any allergies or are you allergic to any medication? *