2024 Online Staff Application Written on March 30, 2023. Camp Staff Application 2024 Camp Selection Camp(*) Elementary Camp Middle School CampHigh School Camp Invalid Input Position Desired(*) Room CoachNurse/EMTInternAnyOther Invalid Input Staff Information First Name(*) Required Middle Name(*) Invalid Input Last Name(*) Required Preferred Name Invalid Input Suffix (Jr., III, etc.) Invalid Input Email(*) Invalid format Address(*) Required City(*) Required State(*) OKAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Required Zip Code(*) Required Cell Phone Invalid Input Alternate Phone Number Invalid Input Gender(*) Male Female Required Date of Birth (mm/dd/yyyy)(*) Required (mm/dd/yyyy) Social Security Number(*) Invalid Input Marital Status(*) SingleMarriedDivorcedWidowedEngaged Invalid Input Spouse Name Invalid Input (If Applicable) Emergency Contact Name Invalid Input Emergency Contact Phone Number Invalid Input T-Shirt Size(*) Adult Small Adult Medium Adult Large Adult XL Adult 2XL Adult 3XL Invalid Input Church(*) Required Pastor(*) Invalid Input Ministries you are involved in Invalid Input Have you worked/attended a Heartland Conference camp previously? Yes No Required If Yes, When and What Position Invalid Input Medical Information Medical Condition(s) or special needs or accommodations the camp needs to be aware of. Invalid Input Born Again YesNo Invalid Input When Invalid Input Baptized with Holy Spirit? YesNo Invalid Input When Invalid Input Do You Use TobaccoDrink Alcoholic BeveragesUse Non-Prescription DrugsTake Medication for Psychological Disorders - If so please listHave any Allergies - If yes please listHave any Handicaps or Conditions that would hinder you from participating in all aspects of camp? - If so please explainHave any Medical Training - If so please list Invalid Input Have you ever been convicted of a criminal offence (excluding minor traffic violations)? If so, explain YesNo Invalid Input Notes (additional info you want to submit) Invalid Input List two personal references (excluding pastor/youth pastor and family members) Reference #1 Name Invalid Input How long have you known this person? Invalid Input Ref 1 Street Address Invalid Input City Invalid Input State Invalid Input ZipCode Invalid Input Phone Invalid Input Reference #2 Name Invalid Input How long have you known this person? Invalid Input Street Address Invalid Input City Invalid Input State Invalid Input Zipcode Invalid Input Phone Invalid Input A Pastor Recommendation is required - please print the form, which is available under downloads, and have your pastor complete it and mail it in! E-Signature(*) I am willing to abide by the camp rules and policies, accept any position or assignment, room in the dorm or cabin to which I am assigned, and if necessary go beyond the duties assigned to my position. I also agree to refrain from unscriptural conduct or any conduct the camp leadership may deem inappropriate. I will fully cooperate in spirit.The information I have provided in this application is correct to the best of my knowledge. I have carefully read all the information provided in conjunction with this application form. I authorize any references or churches listed on this application to provide any information they have regarding my character and/or fitness for service in the Heartland Conference camping program, and I release all such references from liability for any damage that may result from furnishing such evaluations. I do hereby waive the right to examine this information.I authorize the Oklahoma Conference of the Pentecostal Holiness Church (d.b.a Heartland Conference IPHC) to perform a complete background check.This box will serve as an e-signature Required Created on March 30, 2023. Hits: 1453 Print
