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Bethel Deliverance International Church

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Camp Bethel Applications (Camp Leaders, Assistants, Recreational Assistants, Camp Aides)

This form is to be completed by any applicant who is involved with Bethel Deliverance International Church children and youth ministries. We recognize this form is extensive, but ask for your patience in completing the form in its entirety. Your cooperation will assist the church leaders in their efforts to provide a secure environment for you as well as the children and youth who participate in our ministry programs and use our facilities. Your responses will be maintained confidentially, although there may be circumstances where such information may be provided on a "need to know" basis to individuals working with our ministry and to other individuals in order to evaluate your application and/or comply with applicable legal requirements.

NOTE: If you live in a state where laws exempt you from providing any of the information requested, you need not answer the questions requesting requesting such information. For example, you need not disclose information that is constrained in sealed or expunged court records, or that involves a criminal arrest that did not result in conviction.

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Be assured that your comments will be held in strict confidence.

Do you have a contagious or infectious disease or condition which could be transmitted to others in the volunteer work you will be performing?*

Have you ever been convicted of a criminal offense (felony or misdemeanor, except minor traffic violations)? You will need to answer "Yes" if you have entered into a plea agreement, including deferred sentence or deferred judgement arrangements, in connec*

Have you ever been convicted of a sexual offense, offense relating to children or crime of violence (that is not covered in the immediately preceding question)?*

Have you ever been reported to a social agency, law enforcement authority, child abuse registry or similar organization regarding abuse or misconduct involving children?*

Have you had any painful experience (personal abuse in any form) that has better equipped you, or may hinder you from a productive ministry?*

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

Have you ever been the subject of a complaint or disciplinary proceeding against a professional license or other license held you, including, but not limited to a license to provide child care of similar services?*

Have you ever been the subject of any disciplinary action, transfer or dismissal, or been named as a defendant in a civil lawsuit, as a result of an accident or mishap involving children?*

Have you ever been subject to any disciplinary action (including discharge) or investigation by a church, religious, other organization or by an employer?*

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The response I have provided in completing this application form are complete, truthful and accurate. I hereby authorize Bethel Deliverance International Church (hereinafter referred to as "the Church") to make inquiries concerning my background in connection with evaluating the information I have provided on this form and in the application process, including criminal record checks if deemed necessary by the Church. I hereby authorize all persons associated with me, including churches, employers, law enforcement agencies, licensing and social service agencies to release any information contained in their files or records concerning me to the Church and its representatives.

In consideration of the receipt and evaluation of this application form by the Church, I hereby release Bethel Deliverance International Church, Inc. and their directors, employees, agents, representatives and any other person or organization, including record custodians, that may release information concerning me. I also hereby release the Church collectively and individually, from any and all liability for damages of whatever kind or nature which may at any time result to me, my heirs or family on account of inquiries concerning my background and any disclosures of information concerning me to Bethel Deliverance International Church, Inc.

It is desirable that all applicants are members of the local church; if they are not, they must be in full harmony with the doctrines and principles of Bethel Deliverance International Church/Camp Bethel.