Camp Fire USA: Snohomish County Council; Club Leadership Application

Camp Fire USA Volunteer Application

Name:
            First                 Middle                     Last

Phone: H:     W:

Address:

City: State: Zip:

E-mail:

Occupation: Employer:

Which of the following Volunteer positions are you interested in?

Club Leader / Co-Leader	Adult Volunteer	Self Reliance Instructor
Mega Club Leader	Area Service Team

If you are applying for a position working with the children, what children's grade level are you interested in working with?

What School? What School District?

Why do you want to volunteer with Camp Fire USA?

Briefly describe your past experience in working with children.

What are some of your hobbies or special interests?

EMPLOYMENT EXPERIENCE:

Present or Last Employer    From (mo./yr.) To (mo./yr.)    hrs./week

Address                             Supervisor                         Phone

Job Title                             Duties


Previous Employer           From (mo./yr.)  To (mo./yr.)    hrs./week

Address                             Supervisor                         Phone

Job Title                              Duties

VOLUNTEER EXPERIENCE:

Name of Organization        From (mo./yr.) To (mo./yr.)    hrs./week

Address                             Coordinator                      Day Phone

Job Title                             Duties


Name of Organization        From (mo./yr.) To (mo./yr.)    hrs./week

Address                             Coordinator                       Day Phone

Job Title                             Duties

EDUCATION:       Name and Location           Dates Attended
High School:            Diploma GED
                                                                                                  Major            Degree
College:

Other Training:

REFERENCES: Please list three people whom you have known for at least 1 year. These might include professional references, volunteer supervisors and/or personal acquaintances. Please do not list relatives.

	Name	Relationship	Daytime Phone
1.
2.
3.

Are you 18 years or older? Yes No

Do you have any disabilities that would interfere with your ability to perform the
position(s) for which you have applied? Yes No
If yes, please describe:

Camp Fire USA Snohomish County Council's Risk Management Policy states that "No person shall have direct contact with minors in any capacity, on behalf of Camp Fire, who:

a)	Has been convicted by lawful authority of child abuse or any sex related crime(s); or
b)	Within the past ten (10) years, has been convicted by lawful authority in any crime involving or arising out of controlled substance abuse, alcohol abuse, assault, domestic violence, or weapons offense(s); or
c)	Within the past ten (10) years, has been convicted by lawful authority of any crime other than those described in this section, which evidences any physical, mental or emotional threat to the safety or general welfare of minors of family units."
d)	Within the past ten (10) years, has been convicted by any lawful authority of abuse or any sex related crime(s) against any individual, including another adult."

Have you ever been convicted of child abuse, violations of any law or ordinance regulating conduct toward minors or abuse against any adult? Yes No
If yes, please explain.

CAMP FIRE MISSION STATEMENT:
Camp Fire Builds Caring, Confident Youth & Future Leaders!

By submitting this form I certify that the information given in this application is true and complete to the best of my knowledge. I authorize Camp Fire USA Snohomish County Council to investigate all statements contained in this application. I understand that misrepresentation or omission of facts is sufficient cause for immediate dismissal. I have also read and understand Camp Fire's mission statement and will to the best of my ability incorporate it into my work with Camp Fire.