Metropolis of Chicago FANARI CAMP Medical Staff Application
Email address *
Prospective Medical Staff Information
Thank you for your interest in becoming a part of our FANARI CAMP Medical Staff for the 2018 camping season. FANARI CAMP ministers to Greek Orthodox youth ages 11-16.

The 2018 camp dates at The St. Iakovos Retreat Center are as follows:
Staff Orientation: June 1-2
Session I: June 17-23
Session 2: June 24-30
Session 3: July 8-14
Session 4: July 15-21

MEDICAL REQUIREMENTS:
Medical professional (Doctor, PA, Nurse, NP, EMT) with current licenses and documentation available.

We are thankful for your desire to share your talents and serve as a volunteer for the Metropolis of Chicago FANARI Medical Staff. Please feel free to contact me with any questions or for additional information.

In Christ,

Dn. Chris Avramopoulos, Director
Fanari Camp & Youth and Young Adult Ministries
cpavro@aol.com
708-288-2876

Personal Information
Last Name *
Your answer
First Name *
Your answer
Birthdate *
Your answer
Social Security #
Your answer
Gender *
Home Address *
Your answer
Cell Phone Number *
Your answer
Home Parish *
Name, City, State
Your answer
What Camp Session(s) are you available for? *
Required
Professional Information
Please provide your history of medical licenses and schools *
Your answer
Current Medical Profession *
Your answer
Please, confirm which position you are applying for *
Have you had any judgments against you for malpractice? *
Have you had any previous experience as Medical Staff at a summer camp? If "Yes", where? *
Your answer
What interests you in the position of Fanari Camp Medical Staff? *
Your answer
Employment History
Company Name; Position held; Dates of Employment
Current Employer *
Your answer
Previous Employers *
Your answer
Professional Reference
Name *
First and last name
Your answer
Phone number *
Your answer
Email Address *
Your answer
How long have you known this person? *
Your answer
Code of Conduct for the Protection of Children and Youth
To the best of my knowledge, the information contained in this application is complete and accurate. I understand that providing false information is grounds for not hiring me or choosing me for a volunteer position or for my discharge if I have already been hired or chosen. I authorize any person or organization, whether or not identified in this application, to provide any information concerning my previous employment, education, credit history, driving record, criminal conviction record, sexual offender registry or other qualifications for my employment or volunteering. I also authorize the FANARI CAMP to request and receive such information.

If hired or chosen, I agree to be bound by FANARI CAMP policies and procedures, including but not limited to the Greek Orthodox Archdiocese Youth protection and Procedures for Event Staff. I understand that these may be changed, withdrawn, added to or interpreted at any time at FANARI CAMP sole discretion and without prior notice to me. I also understand that my employment or volunteering may be terminated, or any offer or acceptance of employment or volunteering withdrawn, at any time, with or without cause, and with or without prior notice at the option of FANARI CAMP or myself.

Nothing contained in this application or in any pre-employment or pre-volunteering communication is intended to or creates a contact between myself and FANARI CAMP for either employment, volunteering or the providing of any benefit.

Signature *
I have read and understand the above provisions
Your answer
Have you ever been accused of physically, sexually or emotionally abusing a child or an adult? *
I agree to do my best to prevent abuse of children and youth involved in Fanari Camp. *
I agree not to physically, sexually or emotionally abuse or neglect a child or youth. *
I agree to comply with the Greek Orthodox Archdiocese Youth Protection Manual Policies and Procedures for Event Staff (the “Policy”) developed by the Greek Orthodox Archdiocese of America in cooperation with Praesidium, Inc. *
In the event that I observe any inappropriate behaviors or possible policy violations with children or youth, I agree to immediately report my observations to my supervisor and/or to appropriate state authorities as may be required by law, and as otherwise may be required under the Policy. *
I specifically acknowledge my obligation and responsibility to protect children and youth and agree to report known or suspected abuse of children or youth to appropriate church leaders and state authorities in accordance with the Policy and applicable law. *
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I understand that, if chosen, I am an at-will employee or volunteer and can be removed from my position at any time and for any reason, or no reason, in the sole discretion of FANARI CAMP. In addition, and without limiting the above, a. FANARI CAMP (the “Program”) may, in its sole discretion, deny the application of any person who answers yes to the following question: “Have you ever been accused of physically, sexually or emotionally abusing a child or an adult?” If I am selected, and the Program later discovers circumstances that would indicate a “yes” answer to the above question, I may be terminated immediately. b. The information provided on this form is subject to verification, which may include, but not be limited to, a criminal history check and request for information from any Central Registry of child abusers. c. The Program may, in its sole discretion, terminate employment or volunteer service of any person if that person is found, regardless of when discovered, to i. have been the subject of any complaint(s) of abuse of a minor, whether or not criminally charged or the subject of a civil suit; ii. have resigned, been terminated or been asked to resign a position whether paid or unpaid, due to complaint(s) of sexual abuse of a minor; and/or iii. have falsified or omitted information in this disclosure statement
Signature *
Please sign your name to indicate your understanding and agreement with the Code of Conduct stated above.
Your answer
Social Networking and Digital Communication Policy
The Greek Orthodox Archdiocese of America requires that staff observe the following policies:

FRIENDS & CONNECTIONS: Youth workers are prohibited from initially contacting or requesting “friends” under the age of 18. Because you are in a position of authority as a youth worker, a young person may feel obligated to “accept” your friend request. If a young person requests your “friendship” on a social networking site, or if you are already “friends” with minors, you are strongly encouraged to set stringent privacy settings in order to maintain appropriate boundaries. APPROPRIATE CONTENT AND BEHAVIOR: Any interactions with a young person through digital communication should be appropriate and professional and serve as a reflection of these policies. Any inappropriate content on your profile/site or “tagged” to your profile/site must be removed. This applies to anything and everything on your profile/site, including both event and non-event content, i.e. personal photos, event orientation or break, etc. If another individual posts inappropriate content on your profile/site, you should immediately remove it and notify them to refrain from posting inappropriate content in the future. You should monitor your own profile/site regularly to make sure that you are reasonably aware, at all times, of its content. Youth workers must not use blogs, personal pages or websites to disparage the event, its staff, employees, other individuals, or the Greek Orthodox Archdiocese of America. Youth workers must not use social networking sites to share content prohibited by the event or Greek Orthodox Archdiocese of America policies, and not consistent with an Orthodox Christian lifestyle. This includes the abuse of alcohol and drugs, sexual behavior, sexual harassment, bullying, or use of obscenities, profanity, or vulgar language. REPORTING PROCEDURE:If you receive any inappropriate digital communication or content from a young person, you must immediately notify your direct supervisor, i.e. Event Director, Metropolis Youth Director, Metropolis Chancellor, etc. If a young person reveals abuse or inappropriate interactions of any kind with an adult, you must immediately notify your direct supervisor, i.e. Event Director, Metropolis Youth Director, Metropolis Chancellor, etc. If you have additional questions about reporting procedures, please refer to the “Reporting” section of the Policies and Procedures for Event Staff. Any youth worker found to be in violation of any portion of this policy will be subject to immediate disciplinary action, and may include the youth worker’s immediate dismissal from the staff and exclusion from future programs, events and activities at the discretion of your direct supervisor, i.e. Event Director, Metropolis Youth Director, Metropolis Chancellor, etc.
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Acknowledgement, Release and Signature
To the best of my knowledge, the information contained in this application is complete and accurate. I understand that providing false information is grounds for not hiring me or choosing me for a volunteer position or for my discharge if I have already been hired or chosen. I authorize any person or organization, whether or not identified in this application, to provide any information concerning my previous employment, education, credit history, driving record, criminal conviction record, sexual offender registry or other qualifications for my employment or volunteering. I also authorize FANARI CAMP to request and receive such information. If hired or chosen, I agree to be bound by FANARI CAMP policies and procedures, including but not limited to the Greek Orthodox Archdiocese Youth Protection Manual Policies and Procedures for Event Staff. I understand that these may be changed, withdrawn, added to or interpreted at any time at FANARI CAMP'S sole discretion and without prior notice to me. I also understand that my employment or volunteering may be terminated, or any offer or acceptance of employment or volunteering withdrawn, at any time, with or without cause, and with or without prior notice at the option of FANARI CAMP or myself. Nothing contained in this application or in any pre-employment or pre-volunteering communication is intended to or creates a contract between myself and FANARI CAMP for either employment, volunteering or the providing of any benefit. I HAVE READ AND UNDERSTAND THE ABOVE PROVISIONS.
Signature *
Your electronic signature is legally binding.
Your answer
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