Conference Staff Application

Conference

Conference you are applying for*
Labor Day FamilyPost High11/129/107/84/5/6

I desire to serve the Lord as ... for the conference indicated:
CounselorKitchen Staff**Other

Are you applying for other conferences?
YesNo

If yes, which?
Labor Day FamilyPost High11/129/107/84/5/6

Information

Full Name*

Phone (if applicable)

Email

Street Address*

City*

State*
ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip Code*

Gender*
MaleFemale

Are you 18 years of age or older?* ***
YesNo

***Staff who are eighteen or over 18 must have their background clearances in hand before applying to serve. Contact the director of the conference you are applying for for additional information.

If no, provide your date of birth

Certifications (i.e. Lifesaving, EMT, LPN, RN, First Aid, CPR, etc)

Do you play any instruments?

Can you read music?
YesNo

Have you ever been convicted of a felony? (A conviction will not automatically disqualify job candidates. Seriousness of crime and date of conviction will be considered.)
YesNo

If yes, please explain

Consideration

Please explain why you wish to be considered for the position you are applying for.*

References

Please provide two (2) non-related references from people in the following areas of your life.
1. Spiritual Reference: pastor, youth pastor or spiritual counselor (listed under Church Involvement)
2. Ministry/Work Reference: former employer (listed under Work Experience)

Church Involvement

I am currently ... (check one) at*
a communicant membera non-communicant memberattending in good standing

Church Name*

Pastor's Name*

Pastor or Church Email* ****

****If applying for a Counselor position, your pastor will be contacted directly for a letter of recommendation.

Phone*

Address*

City*

State*
ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip Code*

Ministry/Work Experience

French Creek, Camp, Ministry, Work, or Other Experience (MOST RECENT)

Experience listed belowI have no such experience

Ministry/Work

Address

City

State
ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip Code

Supervisor

Phone

Email

Responsibilities

Work Reference - Letter of Recommendation (if applicable)

Emergency Contact Information

In the event of an emergency, contact

Primary Contact Full Name*

Primary Contact Phone*

Relationship to Applicant*

Secondary Contact Full Name

Secondary Contact Phone

Relationship to Applicant

Insurance & Health Information

The following information MUST be provided, or a photocopy of both sides of the insurance card included with the registration. Any third party medical treatment will be submitted first to the individual’s insurance carrier for payment. Any unpaid or uncovered expenses will then be submitted to FCBC’s insurance carrier for payment. Any remaining balance is the responsibility of the individual treated.

Name of Insured (i.e. the name of the policy holder)*

Insurance Company*

Insurance Company Phone Number*

ID Number*

Group*

Date of Last Tetanus Shot

List any special accommodations (e.g., health, dietary, mental health)

Disclaimer, Acknowledgements, and Signature

Except as indicated above, I am in good health and am therefore fit to participate fully in all activities of the conference, and I give my permission for hospital treatment in the event of an emergency, and to release any and all pertinent medical information.

The words "execution," "signed," "signature," and words of like import in this Agreement or in any amendment or other modification hereof (including waivers and consents) shall be deemed to include electronic signatures or the keeping of records in electronic form, each of which shall be of the same legal effect, validity or enforceability as a manually executed signature or the use of a paper-based recordkeeping system, as the case may be, to the extent and as provided for in any applicable law, including the Federal Electronic Signatures in Global and National Commerce Act, the New York State Electronic Signatures and Records Act, or any other similar state laws based on the Uniform Electronic Transactions Act.

I agree to allow French Creek Bible Conference to use audio, video, still pictures and stories of myself for promotional purposes. This will be done with all due respect to the individual’s right to privacy, and will not indicate my name or any other personal information.

I agree to the disclosure of my personal contact information to French Creek Bible Conference Association staff members and the use of such information by staff members for purposes related to the conferences. I also agree to the disclosure of my personal contact information to the Orthodox Presbyterian Church. I give my permission to contact me through social networking sites.

I agree that any claims or disputes I have or may have with French Creek Bible Conference Association or its staff will be settled by Biblically-based mediation and if necessary, legally binding arbitration in accordance with the provisions of Article XII of the Bylaws of French Creek Bible Conference Association.

If accepted as a volunteer, I agree to complete the necessary French Creek Bible Conference volunteer background check and Pennsylvania state law requirements in a timely manner. I also agree to abide by all the rules and regulations ("Behavioral Agreement") set forth by the French Creek Bible Conference Association and promise to abide by these rules and regulations throughout the conference. I understand that my volunteer service can be terminated AT WILL, with or without cause, at any time, either at my option or at the option of the conference director.

Please be aware of the Technology Policy in place for youth conferences.

I will be attending my own age-appropriate conference this summer as a camper.
YesNo

If no, explain

Applicant's Signature*

Date Signed*

 
The following is required for all conference staff who will be under age 18 during the conference:

I certify and agree that my child and I will be bound by the provisions listed above and where my child’s consent is legally insufficient, I hereby consent on his or her behalf to the provisions above.

Parent's Signature

Date Signed

A separate application must be completed for each conference where you would like to serve.