DIRECTIONS: Please Read All Enclosed Pages, Complete Those to Be Returned And

PAID STAFF FORMS

Grand Mesa Methodist Christian Camp

DIRECTIONS: Please read all enclosed pages, complete those to be returned and

return to the Camp Registrar 1 month prior to the

beginning of camp

Paperwork checklist:

_____Signed Contract

_____Three References (see below- you may also attach letters of reference)

_____Staff Application

_____Child Abuse and Sexual Harassment Sign-off form

_____Staff Health Form (signature from a physician for nurse practitioner verifying a physical exam within 12 months of the start of the camp

_____Current W-4 Form (if working all three weeks or making over $500.)

_____Current W-9 Form (if working all three weeks or making over $500.)

_____Employment Eligibility Verification (I-9 form) (if working all three weeks or making over $500.)

_____Central Registry inquiry form (fingerprint form). ONLY if not submitted in previous years

_____CDHS Form (Background Investigation Facility Inquire Form) this is ONLY if not submitted in previous years

_____First aid-CPR course certification (if applicable)

_____Copy of Driver’s License

_____Copy of Nurse or Nurse Aid License/card copy (Camp Nurse)

_____Copy of Social Security Card

_____Copy of your Food Handler’s Card(Camp Cook and Assistant Cook)

Anna Marie Gorman

Grand Mesa Camp Registrar

2703 Cancun Ct., Grand Junction, Co 81506

970-261-1360

970-243-4824

Grand Mesa Methodist Camp

Paid Staff Application

Name ______

Last First Middle

Address ______

Street or Box City State Zip

Date of Birth ______Phone ( )______E-Mail ______

Social Security Number ______Drivers License Number ______

Required: Attach a clear, readable photocopy of your driver’s license. If you do not have a driver’s license, please provide another photo-identification.

Age ______Height ______Weight ______

Education: High School ____ College ____ Graduate School _____ Occupation ______

Camp(s) Applying For ______

Camp Dates ______to ______

Applicable certificates: If you have a current Red Cross Life Saving (Water Safety Person), Sr. Life Saving, EMT, First Responder, Food Handler, climbing or Rafting Certification, please list and attach a copy of certification: ______

Do you have any physical limitations, if so please list: ______

______

Church you are a member of: ______

Church Address: ______Phone ( )______

Current Church Activities ______

Camp/Youth Leadership Experiences (type of work performed and dates) ______

______

Interests and Hobbies______

______

Capacity you would like to serve at camp (Nurse, Water Safety Person, Cook, Dishwasher, etc)

Why are you interested in working at Grand Mesa Methodist Camp? ______

______

______(continued)

______

I affirm that I have not been convicted of any charges of child abuse or neglect, unlawful sexual offense, or any felony. I agree to a background check.

______

(Signature)(Date)

Do you have criminal charges pending? YES ______NO ______

Please provide the names, addresses, and phone numbers of three people (not relatives) that we may contact as personal references. Also please provide the time of day that is best to contact each person. NOTE: Information provided by all references is confidential and will not be made available to the Volunteer by the camp under any circumstance.

Name ______

FirstLast

Address ______

StreetCityState Zip

Years they have known you ______Work Phone ( ) ______Home Phone ( )______

Relationship to you (teacher, employer, coach, etc.) ______Best time to contact ______

Name ______

FirstLast

Address ______

StreetCityState Zip

Years they have known you ______Work Phone ( ) ______Home Phone ( )______

Relationship to you (teacher, employer, coach, etc.) ______Best time to contact ______

Name ______+______

First Last

Address ______

StreetCityState Zip

Years they have known you ______Work Phone ( ) ______Home Phone ( ) ______

Relationship to you (teacher, employer, coach, etc.) ______Best time to contact ______

Any applicant who knowingly or willfully makes a false statement of any material fact or thing in the application is guilty of perjury in the second degree as defined in Section 18-8-503, C.R.S., and upon conviction thereof, shall be punished accordingly.

Signed ______Date ______

In case of emergency, please notify: Name: ______

Relationship: ______Phone: ______

Workplace: ______Phone: ______

Cell phone: ______email: ______

08/13

Staff Reference #1

The following individual has applied to Grand Mesa Christian Association Methodist Camps as a volunteer. They have given us your name as a reference. We have implemented a written reference policy as a portion of our volunteer selection process. It is our desire to provide the best possible camping experience to all campers and this means we obtain the services of quality youth and adults as volunteers.

Grand Mesa Christian Association Methodist Camps will keep all information provided by you, as a reference, confidential. This information will not be made available to the volunteer in any manner including written, verbal or any other means.

Please take a moment to complete this form. It needs to be returned as soon as possible in the enclosed stamped, addressed envelope. Thank you in advance for your time and concern.

Applicant ______Camp applied for ______

Position applied for by volunteer ______Age of campers ______

Name of reference ______

Reference address ______

Street or Box City State Zip

May we call you? ______Best time to call ______

If you work, may we contact you at work? Yes ______No ______Phone Number ______

How long have you known this applicant? ______

In what capacity do you know this person? ______

When was the last time you spoke with this person? ______

In your judgment, is the applicant capable of serving in the capacity they desire, for the age of campers at the camp they have applied for? Yes _____ No _____ if no, would another age group or position be better suited for this individual? Please explain.

______

To your knowledge, has the applicant ever been accused of or charged with a felony or misdemeanor, including alleged sexual offenses (other than a misdemeanor traffic offense)? If yes, please attach an additional sheet and provide complete information to when, where and the type of accusation or charge. Yes _____ No _____

What church activities does the applicant actively participate in?

______

(continued)

What can you tell us about the applicant’s relationship with Jesus Christ?

______

In your opinion, why would this person make a good volunteer at the Grand Mesa Christian Association Methodist Camp mentioned on the reverse side of this form? Please explain:

______

Additional comments, observations or concerns.

______

(Optional) Please tell us a little about yourself (e.g., vocation, church involvement, camp experiences, etc.) ______

______

Statement of Endorsement

The person who has recommended you as a reference will be working with young people in a Christian Camp setting. It is important they are a person of integrity, they relate well to youth and that their attitudes, faith, and behavior is an exemplary model for young people.

Do you believe this applicant meets these criteria? Yes ______No ______

Signed ______Date ______

After completion return this form to:

Anna Marie Gorman

Grand Mesa Camp Registrar

2703 Cancun Ct, Grand Junction, Co 81501

Thank you for your time and input.

Staff Reference #2

Please take a moment to complete this form. It needs to be returned as soon as possible in the enclosed stamped, addressed envelope. Thank you in advance for your time and concern.

Applicant ______Camp applied for ______

Position applied for by volunteer ______Age of campers ______

Name of reference ______

Reference address ______

Street or Box City State Zip

May we call you? ______Best time to call ______

If you work, may we contact you at work? Yes ______No ______Phone Number ______

How long have you known this applicant? ______

In what capacity do you know this person? ______

When was the last time you spoke with this person? ______

______

What church activities does the applicant actively participate in?

______

(continued)

What can you tell us about the applicant’s relationship with Jesus Christ?

______

In your opinion, why would this person make a good volunteer at the Grand Mesa Christian Association Methodist Camp mentioned on the reverse side of this form? Please explain:

______

Additional comments, observations or concerns.

______

(Optional) Please tell us a little about yourself (e.g., vocation, church involvement, camp experiences, etc.) ______

______

Statement of Endorsement

Do you believe this applicant meets these criteria? Yes ______No ______

Signed ______Date ______

After completion return this form to: Anna Marie Gorman

Grand Mesa Camp Registrar

2703 Cancun Ct, Grand Junction, Co 81501

Thank you for your time and input.

Staff Reference #3

Please take a moment to complete this form. It needs to be returned as soon as possible in the enclosed stamped, addressed envelope. Thank you in advance for your time and concern.

Applicant ______Camp applied for ______

Position applied for by volunteer ______Age of campers ______

Name of reference ______

Reference address ______

Street or Box City State Zip

May we call you? ______Best time to call ______

If you work, may we contact you at work? Yes ______No ______Phone Number ______

How long have you known this applicant? ______

In what capacity do you know this person? ______

When was the last time you spoke with this person? ______

______

What church activities does the applicant actively participate in?

______

(continued)

What can you tell us about the applicant’s relationship with Jesus Christ?

______

In your opinion, why would this person make a good volunteer at the Grand Mesa Christian Association Methodist Camp mentioned on the reverse side of this form? Please explain:

______

Additional comments, observations or concerns.

______

(Optional) Please tell us a little about yourself (e.g., vocation, church involvement, camp experiences, etc.) ______

______

Statement of Endorsement

Do you believe this applicant meets these criteria? Yes ______No ______

Signed ______Date ______

After completion return this form to: Anna Marie Gorman

Grand Mesa Camp Registrar

2703 Cancun Ct, Grand Junction, Co 81501

Thank you for your time and input.

DIRECTOR AND PAID STAFF SIGN-OFF SHEET

CHILD ABUSE AND SEXUAL HARASSMENT

Agreement/Sexual Harassment

As a volunteer at Grand Mesa Methodist Camp, I promise to support the mission of the camp and to provide a place where people can enjoy the work of God’s creation and come to know the work of God and Jesus Christ better. I recognize that the Camp is an important part of the ministry of the United Methodist Churches of the Rocky Mountain Conference and I agree to conduct myself in a way that will enhance this ministry.

I understand that as a volunteer I will receive housing and meals but no other remuneration or contribution towards my expenses. I agree to sleep where assigned and take meals at times that will permit me to provide supervision and service to campers. I understand and will comply with the following requirements for volunteers.

I will model affirming Christian behavior in all relationships.
I will not use any language, verbal or nonverbal, that would be considered inappropriate in a Christian home setting. In particular, I will not use any language that carries a sexual connotation, takes the Lord’s name in vain, or belittles an individual’s or group’s ethnic background or heritage.
I will not touch another person or allow another person to touch me in the private areas of the body. “Private area” means that part of the body that would be covered by a modest swimsuit.
I will not touch any part of the body of another person unless it is very clear that the person being touched welcomes the touch (such as a comforting hug) and will not perceive the touch as sensual, sexual, forceful or unwanted. If I am in doubt whether the person welcomes the touch, I will not touch.
I will not allow myself to be alone with a camper in a secluded area. If I want or need to talk one-on-one with a camper, I will do so in a highly visible area. A key phrase I will remember is “in the light and in sight.”
I will allow campers to have privacy when dressing and using bathroom facilities, etc.
In depth, one-on-one conversations should generally involve an adult of the same sex as the camper. I will be sensitive to this need and will inform another volunteer or the Camp Director(s) prior to speaking with a camper if a camper needs or desires personal, in depth conversation.
I will immediately report any unusual events not in keeping with these guidelines to the Camp Director(s) and/or Camp Coordinating Committee Chairperson.
I will not make jokes or derogatory comments about the physical or mental attributes of another person.
I will not make any request or demand for sexual favors.
I will not display sexually suggestive pictures, publications or objects.

Policy against Sexual Harassment

The mission of Grand Mesa Christian Association Methodist Camps is to provide a safe place where people can enjoy the wonder of God’s creation and develop as individuals and as Christians. Sexual harassment is a significant violation of the basic principle of mutual respect that underlies our mission and will not be tolerated. Sexual harassment by staff, volunteers, guests, and campers is prohibited and may result in disciplinary action, including dismissal and expulsion from camp and/or legal action.

Specifically, no one shall threaten or insinuate that a camper’s, volunteer’s, guest’s or staff’s refusal to submit to sexual advances will adversely affect that person’s camp experience, housing, safety, personal development, future or employment

(continued)

Other sexually harassing conduct, regardless of by who committed, is expressly prohibited. Such conduct may include, but is not limited to: Unwelcome and offensive sexual advances, propositions, flirtations, and touching or other physical contact: verbal abuse of a sexual nature, sexually degrading comments, display of sexually suggestive picture,

publications, or objects, requests for sexual favors, and any other conduct that might create an intimidating, hostile or offensive environment.

When directed at minors, all conduct of the nature described above shall be considered unwelcome and offensive. Minors shall not be considered to have welcomed or acquiesced to such conduct.

As a volunteer at Grand Mesa Christian Association Methodist Camps I recognize my responsibility to serve in harmony with other staff under the direction of the Camp Director(s), and to be a daily Christian example in my lifestyle. I understand all of the responsibilities involved with my volunteer position. I agree to carry out these responsibilities to the best of my ability. I have read, understand and will comply with the Policy Against Sexual Harassment.

************************************************************************************************

CHILD ABUSE

Identification

Information: All volunteers and paid staff shall receive CORC approved information on identifying and reporting child abuse and neglect.

What Should Be Reported: The following types of known or suspected abuse and/or neglect should be reported:

Physical maltreatment: any injury which is the result of the actions or omissions of a caretaker.
Sexual maltreatment: any sexual contact or sexually exploitative behavior involving a caretaker.
Failure to provide: food, clothing, shelter, or medical care necessary for a child’s growth and development including the timely provision of medical care.
Failure to supervise: to provide monitoring, guidance, structure, restraint or discipline necessary to protect a child from harm.
Emotional maltreatment: acts of omissions of an adult caretaker which could be expected to retard or damage a child’s emotional development or aggravate an existing impairment.
Harmful restraint and/or control: Inappropriate use of restraint, isolation or medication which could harm or endanger a child.

If, however, there is any reason to question whether or not an incident, circumstance or concern should be reported, IT CATEGORIALLY SHOULD! (Identifying and Reporting Child Abuse and Neglect in Out-of-Home Care Settings, Published by the Colorado Department of Social Services).