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Summer Staff Application form Part 2

References

Please include complete address, city, state, and zip code for each reference below.

One reference must be a person of the opposite sex and all references must be non-family members who are at least 18 years old. References should haveknown you for at least 2 years.

*PROVIDING CORRECT EMAIL INFORMATION IS VERY IMPORTANT.

Personal Reference (friend, teacher, coach, etc)

Gender
Male
Female
Multi-line address

You must include the country code

Work or Community Reference (current or former supervisor, co-worker, community leader, etc)

Gender
Male
Female
Multi-line address

You must include the country code

Ministry or Church (or Additional Reference) (pastor, small group leader, etc)

Gender
Male
Female
Multi-line address

You must include the country code

Background Information and Legal History

Are you eligible for employment in the US?
yes
no

Proof of citizenship or immigration status will be required uponemployment.

For any "yes" answers to the following questions, please attach a detailed explanation in writing and email to mary@wanercamp.org. An affirmative answer does not necessarily disqualify an applicant from employment.

Do you have any allergies or physical limitations that may require accommodations to perform your job?
yes
no

See job descriptions for full details, but most positions must be able to lift up to 50 lbs and work while standing or walking for several hours.

Do you have a chronic/ recurring illness or current infectious disease?
yes
no
Have you ever been the subject of a civil lawsuit involving sexual misconduct, sexual harassment, sexual abuse or other immoralbehavior or conduct, involving adults or children
yes
no
Were you a victim of sexual abuse or molestation while a child? If you prefer, you may refuse to answer this question, or you maydiscuss your answer in confidence rather than answering on this form.
yes
no
Have you ever been convicted of a criminal offense (felony or misdemeanor) involving moral turpitude or violence? (Crimes ofmoral turpitude involve fraud, theft, or dishonesty). Answer "yes" if you have entered a plea agreement, including a deferredsenten
yes
no
Have you ever been charged with a sexual offense, offense relating to children, or crime of violence?
yes
no
Have you ever been reported to any organization or registry for abuse or misconduct involving children?
yes
no
Do you have any disciplinary action or investigation pending by an employer, other organization, professional association, orlicensing body for violence, sexual misconduct, or misconduct involving children?
yes
no
Have you ever been disciplined or dismissed from any volunteer or employment position for any reason or following anallegation of sexual misconduct, physical aggression, verbal aggression, or other inappropriate behavior or conduct??
yes
no
Have you ever been reprimanded, or asked to leave or end your involvement or work in any program or organization providingservices to children?
yes
no
Have you ever been the subject of a complaint or disciplinary proceeding concerning any professional license or professionalaffiliation held by you?
yes
no
Do you now or have you ever sought out or intentionally viewed child pornography?
yes
no

Applicant Statement

StatementPlease read our Statement of Faith HERE.

I have read and agree with Warner Camp's Statement of Faith
I agree
I do not agree

PLEASE READ CAREFULLY BEFORE SIGNING

I hereby authorize you to contact any references or organizations listed in this application and authorize such references or organizations to release any information contained in their files or records concerning me. In consideration of the receipt and evaluation of this application by Warner Camp, I release Warner Camp, all of its agents, and all such references and organizations from any and all liability for any damage that may result from furnishing such information to you. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application, except what may be required by law.

I specifically authorize Warner Camp to undertake a criminal background check concerning my past. I understand and agree that any information received from the background check will not be disclosed to me except as required by law, and I hereby waive any right I may have to inspect any information provided about me by any person or organization identified by me on this form.

I understand and agree that if I am offered conditional employment with Warner Camp, my appointment is for no definite period and may, regardless of the date or method of payment of my wages or salary, be terminated by either party at any time without previous notice or cause and is subject to change in wages, conditions, benefits and operating policies.

I agree that if Warner Camp employs me, in the future a potential employer may contact Warner Camp or its representatives concerning my work record and my work performance at Warner Camp.

I hereby consent to and authorize persons employed by Warner Camp to divulge any and all information they consider relevant to any person representing him or herself to be an employer or potential employer of mine with respect to my work and/or performance of my job at Warner Camp. This consent specifically includes any information related to any allegation or investigation of child abuse or sexual abuse or molestation in any form.

I agree to a medical examination or inquiry, if requested if I receive a conditional offer of employment, including the analysis for the detection of the use of illegal drugs or controlled substances. I understand that testing positive for drugs or controlled substances could prevent my employment or continued employment by Warner Camp.

I understand and agree that in the performance of my duties as an employee of Warner Camp or after I leave Warner Camp, that I must hold in confidence any and all information that I come in contact with regarding my employer or its business.

I understand and agree that it is critical to the mission and ministry of Warner Camp that all employees conform to the highest standards of safety, interpersonal conduct, and sexual morality. I affirm that I will strictly comply with Warner Camp's policies and procedures, including those concerning child safety and protection, sexual abuse and misconduct, and interpersonal relationships. I understand and agree that failure by me to abide by such policies and procedures may result in my immediate dismissal.

My responses above are true and correct. I understand and agree that any false answers or statements made by me on this application or any supplement thereto, or any false statements made to the representative(s) of Warner Camp during the interview process will be sufficient grounds for not hiring, or immediately discharging me, no matter when discovered.

I HAVE CAREFULLY READ, UNDERSTAND AND AGREE TO THE FOREGOING “APPLICANT STATEMENT” AND FURTHER UNDERSTAND AND AGREE THAT A COPY OF THIS APPLICATION SHALL BE AS VALID AS THE ORIGINAL.

Applicant Statement
I agree
I do not agree
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