Information on this page will be shared with the camp facility and event directors.

Application for Camp Work

Please print clearly: Name: _______________________________________________________________ Address: ____________________________ City, St, Zip: ______________________ Email: ______________________________ Phone: __________________________

Birth Date: ______________

(mm/dd/yyyy)

Age: ___________________ Sex:

M F

I desire/have been requested to serve as: _____________________________________ (Position) __________________________________________ (Camp Event & Location)

Dates Available: ______________________________________________________ Employee Experience Previous Camp Experience: (Identify the types of camps you have served at and when)

Please identify training and certifications: (copies may be requested) Exp. date (mm/yy) Advanced Life Saving ____________________ Red Cross Water Safety __________________ Water Safety Instructor __________________

Exp. date (mm/yy) ARC Lifeguard _________________ CPR Certified __________________ Other: (Please list)

Occupation: Education:

______________________________

Hobbies: Musical Instruments:

Current or previous place of employment: ____________________________________________________________________ (Name, Location) ACTIVITY RESTRICTIONS because of any physical problem or illness? ___ yes ___ no If yes, explain degree of restriction:

References: List three references. Please include two of the following: minister, board member, or youthworker. (1) ___________________________________________ (Name) (Position) (2) ___________________________________________ (Name) (Position) (3) ___________________________________________ (Name) (Position) _____________________________________________ (Phone) (Email) _____________________________________________ (Phone) (Email) _____________________________________________ (Phone) (Email) _____________________________ (Phone)
Campwork Application 2012

In case of emergency, please notify: _________________________________ (Name)

Laestadian Lutheran Church Page 1 of 2

Information on this page will be retained confidentially in personnel records at the LLC office.

Name: _______________________

Birth Date: ___________

Social Security No. ________________________

I verify the answers I have provided in this application are true and accurate. I understand that providing false answers and failing to sign this form will result in my being denied the positions for which I am being considered. I consent to a background check and fingerprinting, if required, and agree to provide any information requested to complete a background check. I authorize verification and sharing of any information provided. I authorize references and employers to supply whatever information they have regarding my character and fitness for the position for which I have applied. I certify I have read, understand, and agree to comply with the Laestadian Lutheran Church Sexual Misconduct Policy. I have read and agree to comply with the LLC Sexual Misconduct Policy.
Digitally signed on:

I certify that this information is true to the best of my knowledge _______________________________________________ (Signature & date) Digitally signed on: If under 18, signature of parent or guardian: _________________________________________________________________ Please contact us if you wish to obtain a copy of any conducted background checks.

Laestadian Lutheran Church

Page 2 of 2

Campwork Application 2012

Laestadian Lutheran Church

Sexual Misconduct Policy The Laestadian Lutheran Church is committed to providing a safe and nurturing environment and protective care for all children, youth, and adults who are involved in church-sponsored activities. The church recognizes that survivors of sexual or physical abuse need the love and acceptance of this church and is committed to assisting and supporting them. It is further a specific commitment of this church to prevent child sexual or physical abuse or misconduct and to report such abuse or misconduct in accordance with federal and state laws. This includes any form of sexual advances, activity, contact, or exploitation involving a minor. It also includes unwelcome sexual remarks and speech or action that creates a hostile, intimidating, or offensive environment. The following statements reflect the commitment of this church: 1. 2. 3. The board will communicate this policy to all church leaders (pastors, directors, etc.) and will review with them the reporting procedures for suspected cases of sexual or physical abuse or misconduct. All staff entitled to compensation must complete a work application form. All paid workers and volunteers working with children or youth will be approved by the appropriate LLC official. The LLC will conduct a criminal background check on all paid staff and volunteers 18 years of age and older who are entrusted with the care and supervision of minors at overnight events where minors are unaccompanied by a parent or guardian. All criminal background checks will be updated periodically. Individuals who have committed and/or been convicted of either child sexual or physical abuse should not volunteer service in any church-sponsored activity or program for children or youth. All volunteers working with children or youth are required to be members of a Laestadian Lutheran Church or of a church in one of our sister organizations for a minimum of six (6) months. Adult workers and volunteers should observe the two adult rule. This requires that an adult is never alone with a child or youth without an adult partner. Should a situation arise in which an adult worker or volunteer has a legitimate reason to be alone with a child, the adult will notify the childs parent or guardian in advance. Advance notification will also be given to the appropriate pastor, church board member, activity director, or LLC official. Workers or volunteers should immediately report any behaviors which seem abusive or inappropriate to the director of the activity, pastor, member of the church board, or LLC official. The director, pastor, board member, or LLC official shall see that each report of suspected cases of sexual misconduct is investigated and, if required, reported to the proper authorities, as required by federal and state laws.

4. 5. 6.

7.

LLC/ February 2012

LLC Sexual Misconduct Policy February 2012