DEEPER 2015

Volunteer Personnel Application – 2 pages

(This app must be filled out by ALL non-students)

This application is to be completed by applicants for voluntary personnel positions involving the supervision or custody of minors. The goal is to assist the Alabama Youth Department of the Assemblies of God in providing a safe and secure environment for the youth that participate in our camp program and use our facilities. Submission of this application does not guarantee your selection asa volunteer personnel. Selection is based on need and a positive recommendation by your pastor. You must be 21 years of age as of Jan. 1, 2015 to serve as personnel. No exceptions will be made.

Personnel Fee: $45PER PERSON (No partial payments)

MAKE ALL CHECKS PAYABLE TO:Alabama Youth Ministries

MAIL COMPLETED APPLICATION AND PAYMENT TO:Post Office Box 235014

Montgomery, Alabama 36123-5014

NameS.S. #

Mailing Address

City St Zip

Home Church City

Pastor Youth Pastor

Email address______Birthdate / / Age ______

Highest education level achievedOccupation:

Cell Phone ( )Work Phone ( )

Marital Status (circle one) Married SingleSex(circle one) Male Female

Do you use tobacco? YES NO Do you use alcoholic beverages? YES NO Do you use illegal non prescription drugs? YES NO

Do you have any physical or mental handicaps that would prevent your involvement in certain types of activities? YES NO

If yes, explain

Are you known to be a carrier of any contagious disease or virus? YESNOIf yes, explain

Have you ever been convicted of (or plead guilty to) child abuse or a crime involving actual or attempted sexual molestation of a minor? YES NO

If yes, explain

Have you ever been convicted of a criminal offense? (excluding minor traffic violation) YES NO If yes, explain

Do you have objections to a police check on your background? YES NO (PLEASE MAKE SURE YOU GAVE YOUR SS # AT TOP OF APPLICATION)

What Christian camp experience have you had?

How many times have you served as personnel with the Alabama Assemblies of God camp program?

Are you willing to follow all camp rules and policies as well as submit to authority? YES NO

Are you a born again Christian according to John 3? YES NO When, where, and how were you saved?

SEE 2ND PAGE

OFFICE USE ONLY: Date Postmarked Amount PaidCheck #

Are you baptized in the Holy Spirit with the evidence of speaking in tongues according to Acts 2:4? YES NO

Are you a member of your church? YES NO How long?

Do you attend church regularly? YES NO

Why do you wish to work with our discipleship camp program?

In case of emergency, contact Name Phone Number

Reference Information: Please give the names and phone numbers of your pastor and two other persons not related to you.

This must be complete in order for the application to be processed.

PastorPhone Number( )

Reference #1Phone Number( )

Reference #2Phone Number( )

Applicant’s Statement

The information in this application is correct to the bestof my knowledge. I authorize any references listed on this application to give you any information they may have regarding my character and fitness for work with students. I release you from liability and any damage that mayresult from furnishing such evaluations to you.

Should my application be accepted, I agree to be bound by the rules and policies of the Alabama District Youth Department of the Assemblies of God, and to refrain from unscriptural conduct in the performance of my service on behalf of the camp program. I understand that no babies, or children of any age may be brought to camp for any reason. It is strictly prohibited. If I come to camp with a small child, I understand that I will not be able to stay.

Applicant’s SignatureDate

WitnessDate

PASTOR’S REFERENCE (mandatory for all applicants, unless a credentialed minister with the Alabama District Council of the Assemblies of God)

How long have you known this applicant?In what working relationship?

How do you believe this person will perform as camp personnel?

Do you have any reservations regarding their salvation and motive for serving?

Is there any information that we should personally consider in deciding if this applicant should be a part of our camp program? YES NO

Do you need to speak to me personally regarding this applicant? YES NOComments

Church NameChurch Phone

Senior Pastor’s NameCell Phone

Senior Pastor’s Signature (mandatory for consideration of this applicant) Date

Photocopy as needed