Remembrance Ranch · Remembrance Ranch Summer Staff /Contractor Application

Personal Information

Name *

First Name

Last Name

MIddle *

Maiden Name / /Any other Legal Names Used

Who Referred you to Remembrance Ranch?

Phone *

Email *

Verify Email *

Gender *

Male

Female

Ethnic Background

Social Secruity No. *

Are You 18 years of age or older? *

Yes

No

Date of Birth *

Do you hold a current/valid driver's license *

Yes

No

Drivers License # *

This is helpful for Michigan State background checks

What is your first choice volunteer/staff opportunity *

What is your second choice volunteer/staff opportunity *

What other areas are you willing to consider?

Logistics/camp prep

Office assistance

Child care

Photo/video

Heatlh Officer

Lifeguard

Marketing

Please tell us why you are interested in applying with Remembrance Ranch? *

Current Address

Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Please list all other cities and states you have lived as an adult (18+)

Employment History

Start with your present or most recent employer going back five years.

Employment History for the past five years? *

Please list your Employers, your position, and dates of employment, reasons for leaving.

Education

Education and training levels are relevant for employment only to the extent allowed by law.

School Name, City State, Degree or Certificate, Did you Graduate? *

School Name, City State, Degree or Certificate, Did you Graduate?

Do you hold any current certifications? (CPR, First Aid, First Responder, Lifeguard, CDL, Other)

Please list the type and expiration dates

Church, Ministry, and Volunteer Experience

Please list any other organizations you have volunteered with in the past

Previous church, ministry, or other volunteer Experience

Please provide contact information and dates.

Prior experience working with youth. *

Please describe any experience working with youth in other organizations. Please provide contact information and dates.

Previous Camp Experience *

Please provide contact information and dates.

Personal Reference

Friend, teacher, coach, non-family member, etc.

Name *

Phone *

Email *

Verify Email *

Work or Community Reference

current or former supervisor, co-worker, community leader, non-family member, etc.

Name *

Phone *

Email *

Verify Email *

Ministry or Church (or Additional Reference)

Pastor, past volunteer coordinator, non-family member, etc.

Name *

Phone *

Email *

Verify Email *

Background Information & Legal History

For any "yes" answers to the following questions, please give a detailed explanation. An affirmative answer does not necessarily disqualify an applicant from employment.

Are you eligible for empolyment in the US? *

Proof of citizenship or immigration status will be required upon employment.

Yes

No

Do you have any allergies or physical limitations that may require accommodations to perform your job? *

See job descriptions for full details, but most positions must be able to lift up to 50 lbs and work while standing or walking for several hours.

Yes

No

If YES : please list specific allergies or physical limitations.

Do you have a chronic/recurring illness or current infectious disease? *

Yes

No

If YES : please give explaination of illness or disease.

Have you ever been the subject of a civil lawsuit involving sexual misconduct, sexual harassment, sexual abuse or other immoral behavior or conduct, involving adults or children? *

Yes

No

If YES : please give explaination of lawsuit or harassment case.

Were you a victim of sexual abuse or molestation while a child? If you prefer, you may refuse to answer this question, or you may discuss your answer in confidence rather than answering on this form.

Yes

No

Have you ever been convicted of a criminal offense (felony or misdemeanor) involving moral turpitude or violence? (Crimes of moral turpitude involve fraud, theft, or dishonesty). Answer "yes" if you have entered a plea agreement, including a deferred sent *

Yes

No

If YES : please give a detailed explanation, including date and nature of conviction

Have you ever been charged with a sexual offense, offense relating to children, or crime of violence? *

Yes

No

If YES : please give a detailed explanation, including date and nature of conviction.

Have you ever been reported to any organization or registry for abuse or misconduct involving children? *

Yes

No

If YES: please give detailed explaination of report.

Do you have any disciplinary action or investigation pending by an employer, other organization, professional association, or licensing body for violence, sexual misconduct, or misconduct involving children? *

Yes

No

If YES: please give detailed explaination of disciplinary action.

Have you ever been disciplined or dismissed from any volunteer or employment position for any reason or following an allegation of sexual misconduct, physical aggression, verbal aggression, or other inappropriate behavior or conduct? *

Yes

No

If YES: please give detailed explaination of dismissal.

Have you ever been reprimanded, or asked to leave or end your involvement or work in any program or organization providing services to children? *

Yes

No

If YES: please give detailed explaination or reason for being asked to leave.

Have you ever been the subject of a complaint or disciplinary proceeding concerning any professional license or professional affiliation held by you? *

Yes

No

If YES: please give detailed explaination, including date and nature of complaint.

Applicant Release Statement

Please read our Statement of Faith HERE

I have read Remembrance Ranch's Statement of Faith *

I agree

I do not agree

If hired, I agree to not teach contrary to Remembrance Ranch's Statement of Faith while employed or volunteering with Remembrance Ranch whether or not I agree with it *

I agree

I do not agree

Please Read Carefully Before Signing

I hereby authorize Remembrance Ranch to contact any references or organizations listed in this application and authorize such references or organizations to release any information contained in their files or records concerning me. In consideration of the receipt and evaluation of this application by Remembrance Ranch, I release Remembrance Ranch, all of its agents, and all such references and organizations from any and all liability for any damage that may result from furnishing such information to you. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me in this application, except what may be required by law.

I specifically authorize Remembrance Ranch to undertake a criminal background check concerning my past. I understand and agree that any information received from the background check will not be disclosed to me except as required by law, and I hereby waive any right I may have to inspect any information provided about me by any person or organization identified by me on this form.

I understand and agree that if I am offered conditional employment with Remembrance Ranch, my appointment is for no definite period and may, regardless of the date or method of payment of my wages or salary, be terminated by either party at any time without previous notice or cause and is subject to change in wages, conditions, benefits and operating policies.

I agree that if Remembrance Ranch employs me, in the future a potential employer may contact Remembrance Ranch or its representatives concerning my work record and my work performance at Remembrance Ranch.

I hereby consent to and authorize persons employed by Remembrance Ranch to divulge any and all information they consider relevant to any person representing him or herself to be an employer or potential employer of mine with respect to my work and/or performance of my job at Remembrance Ranch. This consent specifically includes any information related to any allegation or investigation of child abuse or sexual abuse or molestation in any form.

I agree to a medical examination or inquiry, if requested if I receive a conditional offer of employment, including the analysis for the detection of the use of illegal drugs or controlled substances. I understand that testing positive for drugs or controlled substances could prevent my employment or continued employment by Remembrance Ranch.

I understand and agree that in the performance of my duties as an employee of Remembrance Ranch, or after I leave Remembrance Ranch, that I must hold in confidence any and all information that I come in contact with regarding my employer or its business.

I understand and agree that it is critical to the mission and ministry of Remembrance Ranch that all employees conform to the highest standards of safety, interpersonal conduct, and sexual morality. I affirm that I will strictly comply with Remembrance Ranch’s policies and procedures, including those concerning child safety and protection, sexual abuse and misconduct, and interpersonal relationships. I understand and agree that failure by me to abide by such policies and procedures may result in my immediate dismissal.

My responses above are true and correct. I understand and agree that any false answers or statements made by me on this application or any supplement thereto, or any false statements made to the representative(s) of Remembrance Ranch during the interview process will be sufficient grounds for not hiring, or immediately discharging me, no matter when discovered.

Applicant Statement *

I agree

I do not agree

Electronic Signature *