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RFKC NWA Staff Application - Summer 2021
Camp Dates for Summer 2021: June 6-11
Mandatory Training Dates:
April 24, 2021; 9am-3pm
May 1, 2021; 9am-3pm
All information is held strictly confidential. This form must be completely filled out. The information is vital to your acceptance and possible placement as a counselor or support staff.
This form must be completed in one sitting. Please allow 30-45 minutes to complete.
You will need to gather DL#, list of medications, and 3 personal references with a phone #, and email address for each.
Please let us know if you have any questions regarding this application: We look forward to ministering with you.
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Email *
Today's Date *
Current Drivers License # *
(We will take a photocopy of your license at training)
Last four digits of your Social Security Number *
Your Full Social Security number may be required separately to obtain the criminal background check from a third party.
Last Name *
First Name *
Gender *
Birthdate *
Address (street, city, state, zip) *
Age *
Marital Status *
Occupation *
Name of Employer *
Number of Years Employed at Current Employer *
Phone Number *
Emergency Contact Name *
Emergency Contact Phone Number(s) *
Emergency Contact Relationship *
T-Shirt Size *
Certifications *
Select all certifications that you already have.
Do you have previous training or background in dealing with abused, neglected or abandoned children? *
If you have previous training, please explain in what way.
Were you a victim of abuse, neglect or abandonment as a minor? *
If you were a victim of abuse, neglect or abandonment, please clarify.
Please describe why you wish to be a counselor/support staff for abused kids. *
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