Form - Hartland Christian Camp

1Contact/Personal Information

2Spiritual Insight

3Education And Training

4Housing

5Employment History

6References

7Voluntary Disclosure Statement

I will answer the questions below myself and I understand they are used to help guide my internship training. *

I agree not to use AI or others when answering the questions in this application.

It is important for us to know where you are in your walk so that we can prepare to serve you well and help you in key areas during your time with us. Just answer honestly.

Are you transfering after completing an internship at another CCCA Camp? *

No.
Yes, I am finishing up or have completed my existing internship and seeking transfer to Hartland's program.

This let's us know if you're participating in our CCCA Partner Camp Intern Exchange. If you're no sure, just checkbox "no".

Name *

First

Last

How old will you be at the start of the program? (September 1st) *

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? *

This helps us know which areas you can serve in as an intern.

In one sentence, share why are you interested in our internship program? *

Are you a U.S. Citizen? *

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

Interns are not employees but do receive a monthly stipend to help offset living expenses. Because of this, we need to ensure applicants are able to receive payments from Hartland legally while in the U.S.

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

Church attendance *

I attend church regularly (3+ times per month)
I attend church occassionally (less than 12 times per year)
I am not currently attending a church

Name of the church you attend (or campus ministry, etc.) *

Type "n/a" if you are not currently attending a church.

Church City and State:

How long have you attended? (years, etc.)

Pastor's Name (Youth or College Pastor okay here)

Church Phone #:

(you can do a quick Google Search to find this)

Briefly explain the Gospel in one or two paragraphs (in your own words). *

Don't stress about this answer, this is used for part of your internship training, so we know where people are in their walks.

Describe your current relationship with Christ. *

Don't stress about this answer, this is used for part of your personal internship training.

Name of high school you attended *

Put "n/a" if you did not attend High School.

City/State High School is located in: *

Number of years completed *

Did you graduate? *

Name of last college or trade school you attended (if applicable)

We just like to know what schools we may be receiving candidates from, this helps us know how word is spreading about the program.

Course of study

This lets us know if you've had any specialized schooling in areas that could be helpful during the internship.

Please list special interests and hobbies. (We're just getting to know you with this question)

What do you like to do when you have time off and the resources to do it? Example are: hiking, fishing, hanging out with friends, going to the beach, and so on.

Housing

All interns are required to live on-site. To assist us in providing adequate housing expectations, please read and agree to the following:

Community Housing will be provided, meaning you will have multiple roommates and are expected to keep the living space and rooms tidy. *

I understand and agree to this.

I will clean up my own messes and dishes and maintain a generally clean area throughout Hartland-provided housing. *

I understand and agree to keep Hartland's housing clean.

I will limit Utility expenses through good stewardship, including not leaving heat on high or lights on while not home. *

I understand Hartland's ministry funds are covering utilities and will be a good steward of those resources.

I understand I am not able to smoke/vape/drink alcohol on Hartland's Campus or off-campus while enrolled in this program, including during holiday breaks. *

I understand and will abide by this and other Hartland policies.

I will not use incense or candles in Hartland housing due to fire risk. *

I understand and will not have open flames or oil diffusers in Hartland housing (candles, incense, etc.)

I understand boys are not allowed in girl's housing and girls are not allowed in boy's housing, or in those general areas. *

I understand and will not have the opposite sex in or around my group's Hartland-provided housing.

I understand there are no pets allowed in the internship program and will not bring or gather them on site. *

I understand and agree not to bring animals with me to the program or seek pets while here at camp.

Special Needs/Considerations

I am currently *

A recent High School Graduate
Taking a break from College
A recent College Graduate
Other

In a paragraph or two, share what you have been up to lately. (We're just getting to know you with this question) *

How have you been spending your time over the last few months (in college, GAP year, working, etc.)

Pastoral Reference (If you do not have a pastoral reference, include someone that knows about your Christian Faith)

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.

Pastoral Reference Name *

First

Last

Relationship *

Phone *

Email *

Personal Reference (these help us get to know you and how to help you succeed if selected for the program)

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 *

Voluntary Disclosure Statement

List previous residence(s). Include colleges and home residence(s). List most recent address first. This is info used for the background check process.

Prior City/State you lived in (if different from your current address)

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?

These questions are never fun, but they are required since you will be in close contact with our campers who are often minors.

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 or indecent assault and battery on a mentally retarded person *

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

Rape of anyone or 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 acceptance for an internship to any person who answers "yes" to any one of the 8 questions above. If accepted as an intern and the camp later discovers circumstances that would indicate a "yes" answer to any of the above questions, the internship 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 intern programs 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 internships 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.

I understand this is a voluntary Internship Program, this is not employment and I do not receive a wage or salary. *

I understand this is a voluntary internship program and that I am not an employee of Hartland Christian Camp.

Stipend/Reimbursement *

I understand that Hartland is providing a stipend of $300 per month for accepted interns during the program term. This may be prorated down during periods I am not present on the campus (requested time off and during holiday breaks around Thanksgiving and Christmas).

The stipend acts as a means of helping interns meet existing financial obligations such as car insurance, gas, and snack/food items during their time in the internship. Meals are provided whenever campers are on site.

Signature *

Date *

How did you hear about our Internship Application? *

Google/Online Search
Social Media Post
E-Newsletter
From My College/High School
Other

Housing

Pastoral Reference ***(If you do not have a pastoral reference, include someone that knows about your Christian Faith)***

Personal Reference (these help us get to know you and how to help you succeed if selected for the program)

Voluntary Disclosure Statement

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?

I understand and acknowledge the following:

Pastoral Reference (If you do not have a pastoral reference, include someone that knows about your Christian Faith)