Church Of God Of Prophecy Arizona, Nevada, New Mexico Staff Application/Aplicacion de personal Personal Information/Informacion Name/Nombre: DOB: SSN: Phone: State/Estado: ZIP Code: Current address/Direcion: City/Ciudad: Church information/inFormacion de la iglesia Name/Nombre de la iglesia: Church address/Direcion de la iglesia: How long? Phone: E-mail: Fax: Pastor: Youth Leader/Lider Juvenil: Position/Posicion: Emergency contact/Contacto de emergencia Name/Nombre: Phone: Current address/Direccion: City/Ciudad: State/Estado: ZIP Code: Relation/Relacion: Insurance/Asegugaza Medical Conditions/Condiciones Medicas: Doctor: Allergies/Allergias: Penicilin/Penicilina Bees or Wasp Sting/ piquetes de abeja/abispa Ivy, Oak or Sumac Poisoning Food/Comida Envenenamiento contra el Ivy, Oak o Sumac Other Spiritual Saved/Salvo: Yes Filled Holy Ghost: Lleno del Espiritu Santo: No Yes No Sanctified/Santificado: Yes No Area where you like to serve? : En que Area le gustaria server? Youth Childre n Mandatory training is June 5-6, as part of staff you must be present to fully participate in preparations and camp. /Entrenamiento mandatoria para el persona es Junio 5-6, como parte del personal debe estar presente para poder participar en las preparaciones y en campamaneto. Criminal background checks As part of our efforts to ensure the safety of all campers background checks are performed on every person who wishes to participate as staff. Como parte de nuestro esfuerzo para asegurar el bienestar de todos nuestros camperos por ley es necesario hacer un verificacion de antecedentes a cada persona interesado en ser personal de campamento. Do you give permission to run background check on you? Permite usted hacer una verificacion de antecendentes? Yes No Do you have any felonies? Tiene alguna felonia? Yes No Criminal background? Tiene historia criminal? Signature of Applicant: Date Signature of Applicant's Pastor: Date Signature of Camp Director: Date Signature of Camp Coordinator: Date Regional Overseer: Date Yes No STAFF APPLICATION CHECKLIST Complete Staff application before May 15 to receive scholarship Complete Staff Training Schedule on May 5-‐6 All staff must attend camp training in order to attend camp. You will need to provide confirmation requirements of complying with Church of God of Prophecy staff policy. Did you submit your camp tuition? Make Checks payable to: The Church of God of Prophecy 3779 E. Surrey Ave Phoenix, Arizona 85032 Camp application and tuition must be paid before June 1, 2015 Please contact Camp Coordinators for additional information. Darrell Ojeda#: (602) 397-‐1505 Tagine Ojeda#: (602) 397-‐1507