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RETURNING STAFF APPLICATION
This application is for returning staff members interested in volunteering for Summer Camp 2004

Only those persons who have previously served as GLBC volunteer staff may use this form. This application will only be valid if we have your references and your signature on file from a previous camp session.

Please read the Code of Ethics below... You will be required to confirm that you have read and agree to the terms listed within the Code of Ethics
before submitting your online application.

GREAT LAKES BURN CAMP
STAFF/VOLUNTEER CODE OF ETHICS

1.      Staff/volunteers understand and embrace the mission of Great Lakes Burn Camp and willingly and knowingly accept the concept that the focus and goals of the Camp are directed to the campers.

2.      Staff/volunteers will never leave a camper unsupervised.

3.      Staff/volunteer will never be alone with campers or a camper, except when assisting with personal hygiene or toileting which is permitted by specific Camp policies or in an emergency.

4.      Staff/volunteers will not abuse campers including:

        Physical Abuse      strike, spank, shake, slap

        Verbal Abuse      humiliate, degrade, threaten

        Sexual Abuse      including inappropriate touching

        Mental Abuse      hazing, negative manipulation

5.      Staff/volunteers will use positive guidance techniques including redirection, anticipation of and elimination of potential problems, positive reinforcement, support and encouragement rather than competition, comparison, criticism, or humiliating discipline techniques.

6.      Staff/volunteers must treat with confidence and respect, personal information they learned from campers, subject to the policies on reporting abuse and neglect, as referenced elsewhere in the Great Lakes Burn Camp Manual.

7.      Staff/volunteers will treat with campers of all ethnic, religious and cultural backgrounds with respect and consideration.

8.      Staff/volunteers will portray a positive role model for campers, including but not limited to, maintaining an attitude of respect, loyalty, patience, honesty, courtesy, tact and maturity.

9.      Staff/volunteers will not use profanity or discuss adult subject matter in the presence of campers.

10.  Staff/volunteers will adhere to the dress code for Camp. (See Manual)

11.  Staff/volunteers will not use, posses or be under the influence of alcohol or illegal drugs during camp.

12.  Staff/volunteers are prohibited from having firearms or other weapons while at Camp.

13.  Staff/volunteers must be free of health or psychological conditions that might affect campersí health.

14.  Staff/volunteers will comply with the outlined activities and expectations of their defined roles at Camp and all required activities prior to Camp, which support their roles.

15.  Staff/volunteers are prepared and willing to assist and support campers to meet personal daily needs.

16.  Staff/volunteers will accommodate and be sensitive to the developmental differences and abilities of individual campers.

17.  Staff/volunteers who do not have a pre-existing relationship with a camper will not fraternize with campers (baby sitting, phone calls, email, private lessons) outside of Camp supervised activities or the Camp setting.  Any exception to this policy requires written approval in advance from the sponsoring organizationís Camp Volunteer coordinator or Camp Director.

18.  Staff/volunteers will not offer gifts or money to campers or their families.

19.  Staff/volunteers are required by Michigan State laws to report any suspected abuse or neglect of a child to the Camp Director so that it may be reported to the authorities (Michigan Department of Protective and Regulatory Services and local enforcement agency).  (See Manual)

20.  Staff/volunteers will not make personal disclosures to campers with an attempt to influence individual beliefs, values or lifestyles.

21.  Staff/volunteers will adhere to the outlined policies, procedures and standards of Great Lakes Burn Camp.

22.  Staff/volunteers must agree to provide all criminal and other background check information requested of them and must meet qualification standards established by Great Lakes Burn Camp.

Staff/volunteers must comply with this Code of Ethics throughout placement with Great Lakes Burn Camp and affiliation with the sponsoring organization.  Compliance with the Code of Ethics is a condition of continued involvement with Great Lakes Burn Camp.  I understand that violation of the following standards  may be regarded as engaging in unethical behavior, which could be grounds for immediate termination of roles and responsibilities.

All fields are required to be filled in.  
Any application submitted that is not complete will be considered as INVALID

First Name    Last Name

Occupation     T-shirt size

Position you are applying for

How many years have you volunteered for GLBC?


EMPLOYMENT HISTORY

Present Employer


Since 


Address


Phone number    Supervisor's name
                   

LICENSES/CERTIFICATIONS

Please list any licenses or certifications, which you presently hold or are currently working towards attaining. (i.e. CPR, WSI, EMT, RN, LPN, etc)

Certification  #1                                      Expires


Certification  #2                                       Expires


Certification  #3                                       Expires

ADDITIONAL INFORMATION

Have you ever been convicted of anything other than a minor traffic violation?
(A "yes" answer does not necessarily disqualify you.)
Yes       No

Do you have any physical or mental disabilities, restrictions, or limitations which
would prevent you from performing the job for which you have applied?
Yes       No

CERTIFICATION

I understand that if any of the information I have given in this application and/or subsequent interview is false, I am subject to immediate dismissal if I have been chosen as a volunteer staff person. If I am considered as a volunteer staff person, I authorize the administration of the camp to communicate with the aforementioned employers and references on file in connection with this application. If chosen as a volunteer staff person, I agree to observe all rules and regulations of Great Lakes Burn Camp, Inc. and Pretty Lake Vacation Camp, Inc. I understand that the employee and the employer have the right to terminate the volunteer-staff relationship for any reason.

Check this box if you have read the CODE OF ETHICS listed above this application:
By checking the above box, you agree to all terms within the CODE OF ETHICS.
Non compliance with any of the standards within the Code of Ethics is grounds for dismissal as volunteer staff with Great Lakes Burn Camp Inc. NO EXCEPTIONS WILL BE MADE.
 

Check this box if you understand that staff training is MANDATORY:
If you DO NOT attend staff training, you are subject for dismissal as volunteer staff for
Great Lakes Burn Camp Inc. THERE ARE NO EXCEPTIONS FOR MISSING STAFF TRAINING.


Please check this box if we have your signature on file from a previous application:
Please check this box if we have references on file from a previous application:

--reminder we MUST have your signature and references on file in order for you to use this online application--

AUTHORIZATION FOR BACKGROUND CHECK

I authorize Great Lakes Burn Camp, Inc. to conduct a background check with the State Police and/or proper authorities for the purpose of determining my suitability for staff with
Great Lakes Burn Camp, Inc.


Full Name: First, Middle NAME (not initial) & Last Name


Maiden Name (if N/A, please enter as such)

Street Address

City    State   Zip 
               

D.O.B (mm/dd/yyyy)    Social Security Number

 Driver's License Number     State
             

   
Home Phone

ADDITIONAL INFORMATION
-will be kept confidential-


Email Address


Cell Phone Number


Pager Number
By pressing the submit button you are "signing" this form and stating that all the information contained within the form is true and accurate to the best of your knowledge.