2018 Staff Application Form
This form is being used to help Camp Kesher leaders provide a safe and secure environment for the children and youth that participate in our programs and use our facilities. This form is not an employment application.
Email address *
Staff Status *
Gender *
First Name *
Your answer
Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Entering Camp Kesher
Your answer
Home Address *
Street Address, City, State, Zip
Your answer
How many years at the specified address? *
Your answer
Email Address *
Your answer
Occupation? *
Student, Office Manager, Etc.
Your answer
Main Phone Number *
Your answer
Work Phone Number
Please specify, if available
Your answer
Language(s) that you speak? *
Your answer
Family Situation? *
Required
Do you believe in Yeshua Ha’Mashiach/Jesus the Messiah? *
Do you believe that Yeshua died for our sins and was resurrected on the third day? *
Do you believe in the Triune Godhead (Father, Son and Holy Spirit)? *
Do you believe in the indwelling of the Holy Spirit? *
Have you been mikvehed/immersed/water baptized? *
Please specify Yes or No
Congregation Information *
Congregation Name, Full Address, and Phone Number
Your answer
Congregation Information *
Congregational Leader Name
Your answer
Congregation Information *
Length of Attendance
Your answer
The fruit of the Spirit is: Love, Joy, Peace, Patience, Kindness, Goodness, Faithfulness, Gentleness & Self-control (Galatians 5:22-23). Of these: *
Which are your strongest and weakest (these days)?
Your answer
What musical abilities (if any) do you feel you could offer a ministry? *
Required
Please list any additional experience, whether volunteer or compensated, working with children, including the name of the organization for which you worked, dates of your involvement, age range of the children with whom you worked, and the reason for leaving : *
Your answer
Please list any additional skills, training, gifts, education, callings or other characteristics that you possess that have prepared you for, or that would be useful in, children’s/youth work? *
Your answer
Staff and CIT's are required to get fingerprinted by their respective states, for child protection purposes. Is this something you are willing to do or have done already? *
Verification of fingerprinting will need to be provided
Have you ever abused a minor or engaged in any conduct that could be regarded as child abuse or neglect, including but not limited to murder, abduction for immoral purposes, sexual assault, failing to secure medical attention for an injured child, pandering, crimes against nature involving children, taken indecent liberties with children, neglect of children, obscenity offenses, or similar moral impropriety involving children? *
If yes, please explain:
Your answer
Have you ever been convicted of, or pleaded guilty to, or are there charges pending concerning, any crime or misdemeanor involving actual or attempted child abuse or neglect or sexual molestation in Pennsylvania or in any other jurisdiction, including but not limited to, murder, abduction for immoral purposes, sexual assault, failing to secure medical attention for an injured child, pandering, crimes against nature involving children, taken indecent liberties with children, neglect of children, obscenity offenses, or similar moral impropriety involving children? *
If yes, please explain:
Your answer
Have you ever been convicted of, or pleaded guilty to, or are charges pending concerning, any other crime? (Note: Conviction of a crime that does not involve any risk to children or youth is not an automatic bar to volunteer service with Camp Kesher.) *
If yes, please explain:
Your answer
Because we take very seriously our responsibility to protect the children who participate in our programs and use our facilities, as part of our background check on applicants, we may consult national crime and/or child abuse databases, law enforcement officials, and/or child protective services. Do you have any reason to believe that such a background check on you would disclose any negative information? *
If yes, please explain:
Your answer
Is there any other information that might be relevant to assessing your fitness for working with children and youth? *
If yes, please explain:
Your answer
Additional Comments
Your answer
Applicant’s Statement, Verification and Release *
I hereby affirm and acknowledge, by signing immediately below, that all of the information provided in this application and all of my answers to the foregoing questions are true and complete to the best of my knowledge, and that any misrepresentation or omission may be grounds for rejection or, if later engaged as a volunteer, dismissal. I declare under penalty of perjury that the above is completely true. I authorize you to contact any references or organizations listed in this application and authorize such references or organizations to give you any information they may have regarding my character and fitness for working with children and/or youth. I release Camp Kesher and all such references and organizations from any and all liability for any damage that may result from furnishing such evaluations to you, and I waive any right I may have to inspect references provided on my behalf. I recognize and agree that, as a condition of my volunteer service, I consent to a criminal records and/or background check, realizing the importance of promoting Camp Kesher’s ability to protect those under its care. Should my application be accepted, I agree to be bound by all policies, standards and regulations of Camp Kesher and to refrain from all illegal and/or improper conduct in the performance of my services on behalf of Camp Kesher. I HAVE CAREFULLY READ THE FOREGOING STATEMENT, VERIFICATION AND RELEASE AND KNOW AND UNDERSTAND THE CONTENTS THEREOF. I SIGN THIS STATEMENT, VERIFICATION AND RELEASE AS MY OWN FREE ACT AND UNDERSTAND THAT THIS IS A LEGALLY BINDING AGREEMENT.
MM
/
DD
/
YYYY
Applicant’s Statement, Verification and Release *
Full Name
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Chosen People Ministries.