I want to be a...
VOLUNTEER
PAID STAFF MEMBER
Kitchen staff
I want to be at...
KIDS CAMP
July 1 - 5
FAMILY CAMP
July 14 - 28
YOUTH CAMP
Jul 28 - Aug 2
Position desired...
COUNSELOR
KITCHEN WORKER
CUSTODIAL
NURSERY
ADMINISTRATION
Applicant information
First Name*
Last Name*
Birth Date*
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
19
Marital Status*
Spouses Name*
Mailing Address
Address*
City or Town*
Province*
NL
NS
NB
PE
QC
ON
MB
SK
AB
BC
YK
NT
NU
Postal Code*
Phone*
( ) -
Email Address*
Home Church
Church name*
Pastor*
Occupational Information
Social Insurance Number*
Occupation and Employer*
In Case of Emergency
Contact*
Phone*
( ) -
Other
Do you have children?*
YES NO
If yes, is childcare arranged while at camp?*
YES NO
Have you recently used tobacco or illegal drugs?*
YES NO
Why do you want this ministry?*
How long have you attended your current assembly? - Are you a member?*
Where and when did you accept Christ as your personal Savior*
List all churches you have attended regularly in the last 5 years. Indicate the church name, pastor, denomination and phone number*
Please indicate any previous or present ministry involvement. List the church, supervising pastor, and the capacity in which you minister(ed)*
Have you ever been convicted of a criminal offense?*
YES NO
Have you ever been convicted of a sexually related crime?*
YES NO
Have ever been hospitalized or treated for alcohol or substance abuse?*
YES NO
Do you have a communicable disease?*
YES NO
Are you in treatment for a form of mental illness?*
YES NO
Do you have any physical limitations that would prevent you from performing certain types of activities (ie.: lifting, bending etc.)?*
YES NO
Please list three (3) personal references. 18 years and over, not pastors or relatives. Please indicate their full name, address and telephone number*
Please record any information about your character, conduct, personality or history that could have influence on you ability to serve at a Chrisitan Camp*
Applicants Statement
The information I have provided in this application is correct, to the best of my knowledge. I hereby authorize any references listed in this application to give any information that they may have concerning my suitability for this position. I release all such references from liability for any damage that may result in giving such evaluation.
I will attend all meetings relevant to my employment or volunteering. I will submit to each District authority.
I agree to be bound by the policies, philosophies, and directives of the Maritime District of the Pentecostal Assemblies of Canada regarding this event. I understand that law officials may access this information, under warrant, if requested.
I have read, and will adhere to, the Maritime District Child Protection Policy.
Yes, I agree.
IMPORTANT
Please do not arrive at Camp Evangeline for involvement unless you have been notified of your acceptance. You will be notified ONLY if you are accepted. Please attach an original copy of your Criminal Record Check. Mail this form to: Camp Evangeline, Box 1184, Truro, NS, B2N 5H1.