Form - Hartland Christian Camp

1Contact/Personal Information

2Spiritual Insight

3Education And Training

4Housing

5Employment History

6References

7Voluntary Disclosure Statement

I am applying for:

Full-Time
Part-Time/Temporary
Weekends

What time(s) of the year are you available to work? *

Winter
Spring
Summer
Fall

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Primary Phone *

Secondary Phone

Email *

Primary Social Media Site URL

Example https://www.facebook.com/HartlandCamp

Other names by which you are known (i.e. maiden name)

First

Last

Do you have a Driver's License? *

What type of work are you interested in? *

When are you available to begin work? *

Are there any hours, shifts, or days you cannot or will not work? *

If yes, please explain

Will you work overtime if asked? *

Are you a U.S. Citizen? *

Do you have a Social Security Card? *

Are you legally eligible for employment in the United States? *

Do you authorize Hartland Christian Camp to conduct a background check? *

Church attendance *

I attend church regularly
I am not currently attending a church

Name of the church you attend *

How long have you attended?

Pastor's Name

Church address

Address Line 1

Address Line 2

City

State

Zip Code

Church Phone

Describe how you became a Christian. *

Describe your current relationship with Christ. *

Describe how you maintain a daily relationship with Christ. *

Describe your current involvement in ministry or church activities. *

Name of high school you attended *

Number of years completed *

Did you graduate? *

Name of college(s) you attended

Course of study

Number of years completed

Did you graduate?

Degree or diploma received

Name of business or trade school(s) you attended

Course of study

Number of years completed

Did you graduate?

Degree or diploma received

Other special training or skills (language, machine operation, etc.)

List professional, trade, business, or civic activities, memberships, and offices held. Include all licenses or certificates showing valid dates that may help you qualify.

Please list professional, trade, business or civic activities, memberships and offices held. Include all licenses or certificates, showing valid dates, that may help you qualify.

Please list special interests and hobbies.

Please list any additional information that you feel may be helpful to us in considering your application.

Housing

All full-time employees are required to live on-site. To assist us in providing adequate housing, please supply the following as applicable:

Spouse

First

Last

Dependents

Name

First

Last

Gender

Male
Female

Age

Relationship

Dependents

Add another dependent

Name

First

Last

Gender

Male
Female

Age

Relationship

Dependents

Add another dependent

Name

First

Last

Gender

Male
Female

Age

Relationship

Dependents

Add another dependent

Name

First

Last

Gender

Male
Female

Age

Relationship

Dependents

Add another dependent

Name

First

Last

Gender

Male
Female

Age

Relationship

Dependents

Add another dependent

Name *

First

Last

Gender

Male
Female

Age

Relationship

Special Needs/Considerations

I am currently *

Employed (full-time)
Employed (part-time)
Unemployed

Employment Record

List most recent employment first.

Employer/Company Name

Name of Supervisor

First

Last

Phone

Your Job Title

Start Date

End Date

Reason for leaving

May we contact:

Add another employer

Add another employer

Employer/Company Name

Name of Supervisor

First

Last

Phone

Your Job Title

Start Date

End Date

Reason for leaving

May we contact:

Add another employer

Add another employer

Employer/Company Name

Name of Supervisor

First

Last

Phone

Your Job Title

Start Date

End Date

Reason for leaving

May we contact:

Add another employer

Add another employer

Employer/Company Name

Name of Supervisor

First

Last

Phone

Your Job Title

Start Date

End Date

Reason for leaving

May we contact:

Add another employer

Add another employer

Employer/Company Name

Name of Supervisor

First

Last

Phone

Your Job Title

Start Date

End Date

Reason for leaving

May we contact:

Please explain any periods of unemployment

From

How did you spend your time?

From

How did you spend your time?

Pastoral Reference

Enter the name, phone number, and email of a Pastor, Youth Leader, or someone knowing your relationship with God. By listing the individual below, you are authorizing them to provide Hartland Christian Camp with the information requested. You are releasing him/her from all liability in the sharing of this information. An email will be sent to the individual indicated below, where they will be directed to complete an online reference form.

Personal Reference Name *

First

Last

Relationship *

Phone *

Email *

Personal Reference

Enter the name, phone number, and email of someone who can provide a personal reference. By listing the individual below, you are authorizing them to provide Hartland Christian Camp with the information requested. You are releasing him/her from all liability in the sharing of this information. An email will be sent to the individual indicated below, where they will be directed to complete an online reference form.

Personal Reference Name *

First

Last

Relationship *

Phone *

Email *

Employment Reference

To be completed by an Employer, Teacher, or someone who knows your work ethic, character, and abilities. By listing the individual below, you are authorizing them to provide Hartland Christian Camp with the information requested. You are releasing him/her from all liability in the sharing of this information. An email will be sent to the individual indicated below, where they will be directed to complete an online reference form.

Employment Reference Name *

First

Last

Relationship *

Phone *

Email *

Name *

First

Last

Relationship *

Phone *

Email *

Employment Reference

Add another employment reference

Voluntary Disclosure Statement

List previous residence(s) for last five years. Include colleges and home residence(s). List most recent address first.

Previous Address #1

Address Line 1

Address Line 2

City

State

Zip Code

Add another address

Add another address

Previous Address #2

Address Line 1

Address Line 2

City

State

Zip Code

Add another address

Add another address

Previous Address #3

Address Line 1

Address Line 2

City

State

Zip Code

Add another address

Add another address

Previous Address #4

Address Line 1

Address Line 2

City

State

Zip Code

Add another address

Add another address

Previous Address #5

Address Line 1

Address Line 2

City

State

Zip Code

Have you ever been convicted of any crime including, but not limited to, those listed below and/or any crime similar in any manner to those listed?

Have you ever been convicted of any crime relating in any manner to children and/or your conduct with them? *

Indecent assault and battery on a child under 14 *

Indecent assault and battery on a mentally retarded person *

Indecent assault and battery on a person who has obtained the age of 14 *

Rape *

Rape (with force) of a child under 16 *

Assault with intent to commit rape *

Kidnapping of a child under 16 with intent to commit rape *

Distribution and trafficking of narcotics or other controlled substances *

Intent to commit any of the above crimes *

Have you ever been adjudged liable for civil penalties or damages involving sexual or physical abuse of children? *

Are you now or have you ever been subject to any court order involving sexual or physical abuse of a minor including, but not limited to a domestic order or protection? *

Have your parental rights (if applicable) ever been terminated for reasons involving sexual or physical abuse of children? *

If you answered yes to any of the previous questions on this page, please explain.

I understand and acknowledge the following:

1. Hartland Christian Camp may deny employment to any person who answers "yes" to any one of the 8 questions above. If hired and the camp later discovers circumstances that would indicate a "yes" answer to any of the above questions, employment may be terminated immediately.

2. The information provided on this form is subject to verification, which includes a criminal history check request from any Central Registry of child abusers and/or California Department of Justice. c) Hartland Christian Camp may terminate employment or volunteer service of any person if that person is found, regardless of when discovered, to: 1) have a history of complaints of abuse of a minor; 2) have resigned, been terminated, or been asked to resign from a position whether paid or unpaid, due to complaint(s) of sexual abuse of a minor; and/or 3) have falsified or omitted information in this disclosure statement.

3. Hartland Christian Camp may terminate employment or volunteer service of any person if that person is found, regardless of when discovered, to: a) have a history of complaints of abuse of a minor; b) have resigned, been terminated, or been asked to resign from a position whether paid or unpaid, due to complaint(s) of sexual abuse of a minor; and/or c) have falsified or omitted information in this disclosure statement.

Signature *

Date *