gate2013 intern application

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To: Intern Candidate Enclosed is an internship packet with information about The Gate Annual Youth Conference’s Intern program. It gives information about what it means to be an intern, expectations, responsibilities, financial obligations, reference forms, background check form and an intern application. It is not only a privilege to be an Intern for The Gate but also a privilege for me to have so many amazing people gifted and willing to serve in this capacity. Please read this packet thoroughly and contact me with any questions. I can be reached at 615653111 or [email protected]. Kourtney Brownlow Director of The Gate Annual Youth Conference Aldersgate Renewal Ministries

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This growing youth conference is a four day conference to challenge youth in worship, discipleship, and prayer. Go deeper in your relationship with God and encounter more with one-on-one prayer ministry, relevant small group gatherings, and inspiring teaching. All for for authentic long-lasting spiritual growth.

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Page 1: Gate2013 Intern Application

To:  Intern  Candidate  

Enclosed  is  an  internship  packet  with  information  about  The  Gate  Annual  Youth  Conference’s  Intern  program.    It  gives  information  about  what  it  means  to  be  an  intern,  expectations,  responsibilities,  financial  obligations,  reference  forms,  background  check  form  and  an  intern  application.      

It  is  not  only  a  privilege  to  be  an  Intern  for  The  Gate  but  also  a  privilege  for  me  to  have  so  many  amazing  people  gifted  and  willing  to  serve  in  this  capacity.    Please  read  this  packet  thoroughly  and  contact  me  with  any  questions.    I  can  be  reached  at  615-­‐653-­‐111  or  [email protected].      

 

 

 

Kourtney  Brownlow  Director  of  The  Gate  Annual  Youth  Conference  Aldersgate  Renewal  Ministries                                                        

   

Page 2: Gate2013 Intern Application

What  is  a  Gate  Annual  Youth  Conference  Intern?    This  program  was  implemented  in  2011  as  a  means  for  equipping,  empowering,  and  ministering  to  young  people  between  the  ages  of  18  –  21  who  are  not  yet  old  enough  to  serve  on  the  Gate  Leadership  team,  but  desire  to  work  with  young  people  in  this  capacity.        The  purpose  of  the  Gate  Intern  is  to  come  along  side  of  The  Gate  Annual  Youth  Conference  Director  and  leadership  team  and  assist  in  the  preparation  and  implementation  of  the  conference.    This  is  a  servant’s  role  in  which  the  goal  is  not  to  receive  in  any  capacity,  but  instead  give  wholeheartedly  to  others.      General  Qualifications  

o Must  be  between  18  -­‐21  years  of  age  and  have  already  completed  your  first  year  of  college  or  the  equivalent.      

o Must  attend  church  regularly.    o Must  be  active  in  some  kind  of  ministry  leadership  role  in  your  local  church.      o Must  abstain  from  drugs,  alcohol,  tobacco  products,  and  sexual  impurity.    

 Spiritual  Qualifications  

o Must  be  able  to  communicate  a  clear  calling  to  youth  ministry  either  as  a  vocation  or  a  volunteer.    

o Must  possess  evidence  of  spiritual  growth  and  maturity  o Must  demonstrate  a  growing  knowledge  of  the  faith  through  evidence  of  continued  study  in  the  

Word.    o Have  regular  time  of  prayer  and  personal  devotion.    

 Expectations  of  the  Gate  Intern  

o Engage  in  regular  email  correspondence  with  the  Gate  Director  leading  up  to  the  conference.    Inability  to  respond  to  emails  in  a  timely  fashion  without  reason  would  result  in  disqualification  from  the  intern  program.    

o Arrive  promptly  to  sessions,  meetings,  and  anything  noted  on  the  interns  schedule.  o To  do  whatever  is  asked  without  complaint  or  questioning  unless  it  is  deemed  unethical,  illegal,  

etc.      o Represent  Christ  at  all  times  and  remember  that  as  an  intern  you  are  an  adult  leader  not  a  youth  

participant.    o If  the  Gate  Intern  has  a  dual  role  at  the  conference  such  as  worship  team  member,  drama  team,  

etc.,  he/she  is  still  considered  an  intern  at  that  time  and  all  expectations,  rules,  etc.  apply  for  the  duration  of  the  conference.    

o The  Gate  Intern  should  make  sure  that  all  rules  and  regulations  are  followed  at  all  times.    If  the  intern  feels  they  need  assistance  in  enforcing  such  rules  they  should  immediately  contact  the  Gate  Director  or  a  member  of  the  Adult  Leadership  team  for  assistance.    

 Financial  Responsibility  

o $10.00  application  fee  is  to  be  turned  in  with  your  application.    This  will  pay  for  your  background  check  as  required  of  all  leadership.  

o The  Gate  Intern  is  responsible  for  his/her  own  transportation  to  and  from  the  Conference  site.  o The  Gate  Intern  is  responsible  for  securing  and  paying  for  his/her  own  hotel  room  during  the  

duration  of  the  conference.    (It  may  be  advisable  for  interns  of  the  same  sex  to  split  the  cost  and  get  a  room  together  if  necessary).  

Page 3: Gate2013 Intern Application

o The  Gate  Intern  is  responsible  for  payment  of  all  meals  unless  a  group  meal  is  provided  on  site  for  all  leadership  by  the  Gate  Director.      

 Safe  Sanctuaries    The  Gate  Annual  Youth  Conference  is  a  Safe  Sanctuaries  ministry.    This  means  that  the  ministry  has  implemented  and  abides  by  a  policy  for  the  purpose  of  protecting  the  young  people  attending  this  event.    Strict  rules  are  in  place  to  ensure  the  safety  and  security  of  all  involved,  and  a  violation  of  such  safety  will  result  in  immediate  termination  of  the  internship.        

o All  Adult  leadership,  speakers,  bands,  and  Gate  Interns  will  submit  to  a  criminal    background  check.  

o No  Gate  Intern  will  be  permitted  to  be  ALONE  in  a  room  with  a  youth  (anyone  18  or  under  who  has  not  graduated  high  school).  

o No  Gate  Intern  will  hang  out  with  any  youth  after  curfew  (unless  they  are  a  sibling)  after  11pm.  o Any  Gate  Intern  seen  with  a  youth  (even  a  sibling)  outside  of  their  hotel  rooms  after  curfew  will  

be  immediately  terminated  as  a  Gate  Intern.      o All  adult  leadership  is  encouraged  to  eat  meals  with  youth  attending  the  conference,  however  in  

doing  so  remember  that  you  are  an  Intern  and  represent  the  Gate  and  this  covenant  at  all  times.    o No  public  displays  of  affection  with  a  member  of  the  opposite  sex  unless  they  are  your  spouse  

and  those  displays  should  be  appropriate  and  within  reason.    o Appropriate  touch  should  be  maintained  throughout  the  conference.    Practice  the  “side  hug”  

method  at  all  times.          

v The  purpose  of  not  hanging  out  after  curfew  with  a  youth  is  because  as  adult  leadership  we  believe  that  a  lack  of  sleep  can  hinder  a  person’s  ability  to  be  fully  present  and  awake  and  receive  all  that  God  has  for  them.    It  is  inevitable  that  many  youth  will  choose  to  stay  up  late  at  these  events,  but  no  Gate  leader  should  encourage  or  participate  in  this  activity.    

 Job  Purpose  The  purpose  of  the  Gate  Annual  Youth  Conference  Intern  program  is  to  gain  experience,  training,  and  equipping  in  various  aspects  of  youth  ministry  under  the  direction  of  the  Gate  Director.  These  aspects  could  include  but  are  not  limited  to:  prayer,  preparation,  study,  teaching,  relational  ministry,  leadership  development,  small  group  ministry,  prayer  ministry,  administration,  set  up  &  take  down,  security,  media  &  technology,  crowd  control,  running  errands,  gathering  supplies,  assisting  another  Adult  leader,  speaker  etc.        Duties  and  responsibilities:  

• To  actively  participate  in  various  aspects  of  The  Gate  Annual  Youth  Conference  as  may  be  required  by  the  Gate  Director.  

• To  assist  in  the  planning,  implementation,  and  leading  of  the  Gate  Annual  Youth  Conference  as  may  be  required  by  the  Gate  Director.  

• To  assist  the  Gate  Director  and  all  members  of  the  Adult  Leadership  team  as  needed.      • To  pray  for  and  interact  with  the  participants  of  The  Gate  Annual  Youth  Conference.    • To  report  any  questionable  behavior  to  the  Gate  Director  immediately.    

Page 4: Gate2013 Intern Application

• To  represent  Christ  in  all  areas  while  in  leadership  as  a  Gate  Intern.      The  following  standards  are  considered  priorities  for  all  persons  seeking  an  internship  with  the  Gate  Annual  Youth  Conference.    

§ Spiritual  Development  The  applicant  must  have  a  personal  experience  of  salvation  through  Jesus  Christ,  a  consistent  life  that  brings  glory  to  Him,  and  a  conviction  of  call  to  serve  in  youth  ministry.  

 § Personality  and  Character  

The  applicant  must  have  leadership  abilities  and  exhibit  a  basic  compatibility  with  all  people.    He/She  must  have  a  willingness  to  adapt  to  new  situations  and  show  patience  and  perseverance  under  trial.    He/She  must  have  a  sense  of  humor  and  optimism.    They  must  be  conscientious  in  all  manners  of  work  and  spiritual  life.    

 § Physical  and  Emotional  Health  

The  intern  must  be  in  good  general  health  and  possess  emotional  stablilty.      

§ Organization  Compatibility  Aldersgate  Renewal  Ministries  and  The  Gate  Annual  Youth  Conference  is  a  team  effort.    Each  staff  member,  adult  volunteer  and  Intern  must  be  willing  to  give  to  this  ministry  even  if  it  means  personal  sacrifices.      

 § Calling  

Each  applicant  needs  to  be  able  to  communicate  a  clear  calling  to  serve  in  youth  ministry  as  a  Gate  Intern.    

 Non-­‐Negotiable  Expectations  The  following  are  non-­‐negotiable  expectations  for  getting  the  position  of  Gate  Intern.    

o Submit  this  application  and  references  to  the  Gate  Director  no  later  than  February  1st  2012.  o Submit  your  $10.00  application  fee  with  application.  (Cash  or  Check  made  out  to  ARM)  o Arrive  in  Lexington,  KY  on  Tuesday  July  9thth  2013  by  3:00  pm.    o Depart  from  Lexington,  KY  no  sooner  than  Sunday  July  14th  2013.    o Provide  the  Gate  Director  with  details  of  your  travel  plans  no  later  than  May  1st  2013.  

1. How  are  you  arriving  in  Lexington,  KY?  2. Do  you  need  to  be  picked  up  at  the  airport?  3. What  hotel  are  you  staying  at?  4. What  is  your  confirmation  #?    5. Do  you  have  any  one  else  staying  in  your  hotel  room?  

o Once  you  are  accepted  as  a  Gate  Intern  you  are  expected  to  attend  the  Conference.  Though  you  come  at  your  own  expense  there  are  monies  that  are  budgeted  for  you  as  well.    Failure  to  attend  the  conference  will  result  in  your  repaying  those  monies  and  may  result  in  you  not  being  considered  for  future  leadership.  (emergency  situations  can  be  discussed  if  the  come  up)  

o Respond  to  any    questions  by  phone  or  email  promptly  in  order  to  finalize  your  application.  o Submit  to  a  phone  interview  with  the  Gate  Director  Prior  to  acceptance  as  a  Gate  Intern.    o Submit  to  a  Post  Experience  Evaluation.  (what  went  well,  how  can  we  do  better,  etc.).  

 

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The  Gate  Annual  Youth  Conference  Intern  Application  

 Date:  ________    Basic  Information    Full  Name:  ____________________________   Age:_______   Date  of  Birth:  ___  /  ___  /  ___    Occupation:  ____________________________________________    Home  Address:  _________________________________________________________________    Cell  Phone:  ______________________   SS#  _______________________  (necessary  for  background  check)    

Student  Address:  ________________________________________________________________         (Mail  Can  be  sent  here  until  ________________)    Marital  status:  ____  (single)          ____  (Married)      ____  (engaged)      ____  (wedding  date)    Spouse’s  Name:  ____________________________    Is  he/she  accompanying  you?  ____________    Name  of  Parent/Guardian:  _________________________________________________________    Address  of  Parent/Guardian:  ________________________________________________________    Name  of  School  Attending:  ________________________    Graduation  Year:  __________________    Grade  Point  Average:  ____________      Major:  ___________________________________________    Health:  ____  excellent        ____  good      ____  fair        ____  poor    I  use:  ____  tobacco        ____  alcohol        If  yes,  to  what  extent?  ________________________________    Do  you  have  your  own  transportation?  _______    Denomination:  _____________________        Present  Church  Membership:  _______________________    Pastor’s    Name:  _____________________    Church  Address:  _________________________________    How  long  have  you  been  a  member?  ____________________________________________________                

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Health  Information:    If  you  have  now  or  have  ever  had  any  of  the  following,  please  indicate  below  and  explain  in  autobiography:    ____  Asthma     ____  Migraine  Headaches            ____  Anxiety/Depression    ____  Diabetes  (if  yes  are  you  insulin  dependent?  ____  )                ____  Heart  problems    ____  Eating  Disorders          ____  Addictions  (specify)    _____________________________    ____  Seizures/Epilepsy        ____  Allergies  (specify)    ______________________________    ____  other  illnesses  or  disabilities  (specify)  ___________________________________    References:    List  five  references.    Include  name,  complete  address,  and  relationship  to  you.    Please  include  your  pastor  and  a  peer  as  2  of  the  5  references.  Make  sure  all  of  the  below  reference  receive  and  complete  a  reference  form  included  in  this  packet.      

1. ______________________________________________________________________________    

2. ______________________________________________________________________________    

3. ______________________________________________________________________________    

4. ______________________________________________________________________________      

5. ______________________________________________________________________________    

   Employment  History:  (Please  include  all  previous  internships)    Employer:  ____________________________      Position  held:  ___________________________________    Company  Address:  _____________________________________________________________________    Supervisors  Name:  _______________________________        Phone  Number:  _______________________    Dates  Employed:  _____________________    Reason  for  Leaving:  ________________________________      

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 Employer:  ____________________________      Position  held:  ___________________________________    Company  Address:  _____________________________________________________________________    Supervisors  Name:  _______________________________        Phone  Number:  _______________________    Dates  Employed:  _____________________    Reason  for  Leaving:  ________________________________            Employer:  ____________________________      Position  held:  ___________________________________    Company  Address:  _____________________________________________________________________    Supervisors  Name:  _______________________________        Phone  Number:  _______________________    Dates  Employed:  _____________________    Reason  for  Leaving:  ________________________________        Personal  Information:  List  activities  in  home  church  and  college  church  and  describe  your  role  in  these  areas:          List  School  organizations  you  have  belonged  to,  offices  held,  and  honors  received:        

For  Office  Use  Only    Interview  Date:  ___  /  ___  /___             Conducted  By:  ________________________        Reference  Forms  ____        Biography  _____     Application  _____     $10.00  Fee  ____    Background  Check  Form  ____      Reference  Calls  Made  ____      Comments:  ___________________________________________________________________________  _____________________________________________________________________________________  _____________________________________________________________________________________  _____________________________________________________________________________________  _____________________________________________________________________________________  _____________________________________________________________________________________        

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Biography  Questions    On  a  separate  piece  of  paper  please  communicate  the  following:  

o Communicate  your  calling  to  youth  ministry  in  the  capacity  of  a  Gate  Intern  o What  are  your  expectations  regarding  this  experience  should  you  be  chosen?  o Why  should  you  be  chosen  as  a  Gate  Intern?  o In  500  words  or  less  please  describe  how  you  came  to  be  in  a  relationship  with  God  and  how  

that  relationship  has  grown.  o Describe  your  current  spiritual  growth  and  development  practices.  o Include  a  brief  statement  of  your  beliefs  concerning  the  Bible,  Christ,  Salvation,  evangelism,  and  

discipleship,  and  the  Holy  Spirit.  o List  5  strengths  that  you  bring  to  the  table  as  a  Gate  Intern  and  5  Weakness.  o Do  you  have  experience  preaching/teaching?  If  so  please  describe  that  experience.    

     Please  have  the  following  mailed  no  later  than  February  1st  2013:  

o Application    o $10.00  Application  Fee  o Reference  forms  (sealed  in  individual  envelops)  o Biography  Questions  o Background  Check  Form  

                                               

   

Page 9: Gate2013 Intern Application

The  Gate  Internship  Reference  Form  

 __________________  is  applying  to  become  an  intern  with  The  Gate  Annual  Youth  Conference  and  has  given  your  name  as  a  personal  reference.    The  person  in  this  intern  capacity  will  be  in  close  contact  with  minors.    We  want  to  ensure  that  these  relationships  will  be  healthy  and  that  the  applicant  has  the  emotional  and  spiritual  maturity  to  serve  in  this  role.    Therefore,  please  complete  the  form  below  evaluating  this  person’s  gifts,  character,  and  integrity.    Your  response  will  remain  confidential.      Describe  your  relationship  to  the  applicant:        How  long  have  you  known  the  applicant?    Less  than  6  months  ______                6  mo.  –  1  year        ______                1-­‐3  years  _____                3  or  more  years  ____    Please  use  the  following  scale  to  respond  to  questions  1-­‐6:  1-­‐low     2-­‐  below  average          3-­‐average     4-­‐  very  good     5-­‐  excellent    How  would  you  rate  the  following?  (Circle  one)  

1. Interpersonal  skills         1   2   3   4   5  2. Emotional  Maturity         1   2   3   4   5  3. Conflict  Resolution         1   2   3   4   5  4. Follow  through  with  commitments     1   2   3   4   5  5. Ability  to  relate  to  Jr.  High/Sr.  High  Students   1   2   3   4   5  6. Spiritual  Maturity         1   2   3   4   5  

 What  is  the  applicant’s  greatest  strength?      What  is  the  applicant’s  greatest  weakness?      Do  you  have  any  concerns  or  reservations  about  the  applicant’s  involvement  with  Jr.  or  Sr.  High  students?    If  so,  please  explain.        Thank  you  for  taking  the  time  to  fill  out  this  reference.    Your  input  is  very  valuable  to  us  as  a  youth  ministry.    If  you  have  any  questions  please  feel  free  to  contact  me  at  [email protected]  or  615-­‐653-­‐1111.    Please  seal  this  form  in  an  envelope  prior  to  returning  it  to  the  applicant.        Your  Name:  _________________________    Date:  ________________________    Signature:  __________________________      Email:  ________________________  Phone:  ____________  

Page 10: Gate2013 Intern Application

The  Gate  Internship  Reference  Form  

 __________________  is  applying  to  become  an  intern  with  The  Gate  Annual  Youth  Conference  and  has  given  your  name  as  a  personal  reference.    The  person  in  this  intern  capacity  will  be  in  close  contact  with  minors.    We  want  to  ensure  that  these  relationships  will  be  healthy  and  that  the  applicant  has  the  emotional  and  spiritual  maturity  to  serve  in  this  role.    Therefore,  please  complete  the  form  below  evaluating  this  person’s  gifts,  character,  and  integrity.    Your  response  will  remain  confidential.      Describe  your  relationship  to  the  applicant:        How  long  have  you  known  the  applicant?    Less  than  6  months  ______                6  mo.  –  1  year        ______                1-­‐3  years  _____                3  or  more  years  ____    Please  use  the  following  scale  to  respond  to  questions  1-­‐6:  1-­‐low     2-­‐  below  average          3-­‐average     4-­‐  very  good     5-­‐  excellent    How  would  you  rate  the  following?  (Circle  one)  

1. Interpersonal  skills         1   2   3   4   5  2. Emotional  Maturity         1   2   3   4   5  3. Conflict  Resolution         1   2   3   4   5  4. Follow  through  with  commitments     1   2   3   4   5  5. Ability  to  relate  to  Jr.  High/Sr.  High  Students   1   2   3   4   5  6. Spiritual  Maturity         1   2   3   4   5  

 What  is  the  applicant’s  greatest  strength?      What  is  the  applicant’s  greatest  weakness?      Do  you  have  any  concerns  or  reservations  about  the  applicant’s  involvement  with  Jr.  or  Sr.  High  students?    If  so,  please  explain.        Thank  you  for  taking  the  time  to  fill  out  this  reference.    Your  input  is  very  valuable  to  us  as  a  youth  ministry.    If  you  have  any  questions  please  feel  free  to  contact  me  at  [email protected]  or  615-­‐653-­‐1111.    Please  seal  this  form  in  an  envelope  prior  to  returning  it  to  the  applicant.        Your  Name:  _________________________    Date:  ________________________    Signature:  __________________________      Email:  ________________________  Phone:  ____________  

Page 11: Gate2013 Intern Application

The  Gate  Internship  Reference  Form  

 __________________  is  applying  to  become  an  intern  with  The  Gate  Annual  Youth  Conference  and  has  given  your  name  as  a  personal  reference.    The  person  in  this  intern  capacity  will  be  in  close  contact  with  minors.    We  want  to  ensure  that  these  relationships  will  be  healthy  and  that  the  applicant  has  the  emotional  and  spiritual  maturity  to  serve  in  this  role.    Therefore,  please  complete  the  form  below  evaluating  this  person’s  gifts,  character,  and  integrity.    Your  response  will  remain  confidential.      Describe  your  relationship  to  the  applicant:        How  long  have  you  known  the  applicant?    Less  than  6  months  ______                6  mo.  –  1  year        ______                1-­‐3  years  _____                3  or  more  years  ____    Please  use  the  following  scale  to  respond  to  questions  1-­‐6:  1-­‐low     2-­‐  below  average          3-­‐average     4-­‐  very  good     5-­‐  excellent    How  would  you  rate  the  following?  (Circle  one)  

1. Interpersonal  skills         1   2   3   4   5  2. Emotional  Maturity         1   2   3   4   5  3. Conflict  Resolution         1   2   3   4   5  4. Follow  through  with  commitments     1   2   3   4   5  5. Ability  to  relate  to  Jr.  High/Sr.  High  Students   1   2   3   4   5  6. Spiritual  Maturity         1   2   3   4   5  

 What  is  the  applicant’s  greatest  strength?      What  is  the  applicant’s  greatest  weakness?      Do  you  have  any  concerns  or  reservations  about  the  applicant’s  involvement  with  Jr.  or  Sr.  High  students?    If  so,  please  explain.        Thank  you  for  taking  the  time  to  fill  out  this  reference.    Your  input  is  very  valuable  to  us  as  a  youth  ministry.    If  you  have  any  questions  please  feel  free  to  contact  me  at  [email protected]  or  615-­‐653-­‐1111.    Please  seal  this  form  in  an  envelope  prior  to  returning  it  to  the  applicant.        Your  Name:  _________________________    Date:  ________________________    Signature:  __________________________      Email:  ________________________  Phone:  ____________  

Page 12: Gate2013 Intern Application

The  Gate  Internship  Reference  Form  

 __________________  is  applying  to  become  an  intern  with  The  Gate  Annual  Youth  Conference  and  has  given  your  name  as  a  personal  reference.    The  person  in  this  intern  capacity  will  be  in  close  contact  with  minors.    We  want  to  ensure  that  these  relationships  will  be  healthy  and  that  the  applicant  has  the  emotional  and  spiritual  maturity  to  serve  in  this  role.    Therefore,  please  complete  the  form  below  evaluating  this  person’s  gifts,  character,  and  integrity.    Your  response  will  remain  confidential.      Describe  your  relationship  to  the  applicant:        How  long  have  you  known  the  applicant?    Less  than  6  months  ______                6  mo.  –  1  year        ______                1-­‐3  years  _____                3  or  more  years  ____    Please  use  the  following  scale  to  respond  to  questions  1-­‐6:  1-­‐low     2-­‐  below  average          3-­‐average     4-­‐  very  good     5-­‐  excellent    How  would  you  rate  the  following?  (Circle  one)  

1. Interpersonal  skills         1   2   3   4   5  2. Emotional  Maturity         1   2   3   4   5  3. Conflict  Resolution         1   2   3   4   5  4. Follow  through  with  commitments     1   2   3   4   5  5. Ability  to  relate  to  Jr.  High/Sr.  High  Students   1   2   3   4   5  6. Spiritual  Maturity         1   2   3   4   5  

 What  is  the  applicant’s  greatest  strength?      What  is  the  applicant’s  greatest  weakness?      Do  you  have  any  concerns  or  reservations  about  the  applicant’s  involvement  with  Jr.  or  Sr.  High  students?    If  so,  please  explain.        Thank  you  for  taking  the  time  to  fill  out  this  reference.    Your  input  is  very  valuable  to  us  as  a  youth  ministry.    If  you  have  any  questions  please  feel  free  to  contact  me  at  [email protected]  or  615-­‐653-­‐1111.    Please  seal  this  form  in  an  envelope  prior  to  returning  it  to  the  applicant.        Your  Name:  _________________________    Date:  ________________________    Signature:  __________________________      Email:  ________________________  Phone:  ____________  

Page 13: Gate2013 Intern Application

The  Gate  Internship  Reference  Form  

 __________________  is  applying  to  become  an  intern  with  The  Gate  Annual  Youth  Conference  and  has  given  your  name  as  a  personal  reference.    The  person  in  this  intern  capacity  will  be  in  close  contact  with  minors.    We  want  to  ensure  that  these  relationships  will  be  healthy  and  that  the  applicant  has  the  emotional  and  spiritual  maturity  to  serve  in  this  role.    Therefore,  please  complete  the  form  below  evaluating  this  person’s  gifts,  character,  and  integrity.    Your  response  will  remain  confidential.      Describe  your  relationship  to  the  applicant:        How  long  have  you  known  the  applicant?    Less  than  6  months  ______                6  mo.  –  1  year        ______                1-­‐3  years  _____                3  or  more  years  ____    Please  use  the  following  scale  to  respond  to  questions  1-­‐6:  1-­‐low     2-­‐  below  average          3-­‐average     4-­‐  very  good     5-­‐  excellent    How  would  you  rate  the  following?  (Circle  one)  

1. Interpersonal  skills         1   2   3   4   5  2. Emotional  Maturity         1   2   3   4   5  3. Conflict  Resolution         1   2   3   4   5  4. Follow  through  with  commitments     1   2   3   4   5  5. Ability  to  relate  to  Jr.  High/Sr.  High  Students   1   2   3   4   5  6. Spiritual  Maturity         1   2   3   4   5  

 What  is  the  applicant’s  greatest  strength?      What  is  the  applicant’s  greatest  weakness?      Do  you  have  any  concerns  or  reservations  about  the  applicant’s  involvement  with  Jr.  or  Sr.  High  students?    If  so,  please  explain.        Thank  you  for  taking  the  time  to  fill  out  this  reference.    Your  input  is  very  valuable  to  us  as  a  youth  ministry.    If  you  have  any  questions  please  feel  free  to  contact  me  at  [email protected]  or  615-­‐653-­‐1111.    Please  seal  this  form  in  an  envelope  prior  to  returning  it  to  the  applicant.        Your  Name:  _________________________    Date:  ________________________    Signature:  __________________________      Email:  ________________________  Phone:  ____________  

Page 14: Gate2013 Intern Application

FORM 1 - AUTHORIZATION FOR THE RELEASE OF INFORMATION FOR BACKGROUND CHECK

United Methodist Renewal Services Fellowship, Inc. Dba: Aldersgate Renewal Ministries

121 East Avenue Goodlettsville, TN 37072 Phone: 615.851.9192 Fax: 615.851.9372 Email: [email protected]

This confidential release is to be completed by team members having involvement with minors at Aldersgate Renewal Ministries (ARM) local church renewal weekends.

PERSONAL INFORMATION

Name: Please indicate: Female __ Male__

Address:

City: State: Zip:

Previous address (if current is less than one year):

City: State: Zip:

Home Phone: Work Phone:

Occupation: Social Security #(required):

Birthdate: Age:

Email Address:

BACKGROUND SCREENING

Have you ever been convicted of a crime? Yes or no. If yes, please explain:

Are there any legal charges pending against you? Yes or no. If yes, please explain:

Race: White___ Black___ Hispanic___ American Indian___ Asian/Pacific Islander___

Page 15: Gate2013 Intern Application

CRIMINAL RECORDS CHECK AUTHORIZATION

I hereby give my permission for Aldersgate Renewal Ministries (ARM) to obtain information relating to my criminal history record for the purposes intended by ARM through this Authorization and Release and the Policy for Those Working with Minors which has been previously disclosed to me. The criminal history record, as received from the reporting agencies, may include arrest and conviction data as well as plea bargains and deferred adjudications. I understand that this information will be used, in part, to assure the safety of minors participating in ARM events. I also understand that as long as I remain active on renewal teams, the criminal history records check may be repeated at any time. I understand that I will have the opportunity to review the criminal history and a procedure is available for clarification, if I dispute the record as received. I also understand that, by law, I may see a copy of the transcript, for its review, but may not receive a copy of the document in any fashion or form. I, the undersigned, do for myself, my heirs, executors and administrators, hereby remise, release and forever discharge and agree to indemnify ARM and each of its officers, directors, employees, and agents harmless from and against any and all causes of action, suits, liabilities, costs, debts, and sums of money, claims, demands, whatsoever, and any and all related attorney’s fees, court costs, and other expenses resulting from the investigation of my background in connections with my application to become a volunteer or employee of ARM.

MINISTRY TO MINORS CODE OF ETHICS AND RULES

While serving in ministry to minors in ARM events, the following shall apply: 1. Smoking or using tobacco products in the presence of minors is prohibited. 2. Using, possessing, or being under the influence of alcohol, illegal, or illicit drugs will not be tolerated. 3. Sponsors and volunteers of minors shall not abuse minors, which shall include, but not be limited to, the following

actions: a. Any direct observations or evidence of sexual activity in the presence of or in association of a minor; b. Any display or demonstration of sexual activity, abuse, insinuation of abuse, or evidence of abusive conduct; c. Infliction or physically abusive behavior or bodily injury to a minor; d. Physical neglect of a minor, including failure to provide adequate supervision in relation to the activities of

ARM; e. Mental or emotional injury to a minor; f. Possession of obscene or pornographic materials at any function of ARM;

4. Limit access to the locked records to the Administrator in the ARM office. 5. Sponsors and volunteers must treat all people of all races, religions, and cultures with respect and consideration. 6. Sponsors and volunteers shall not use or tolerate the use of profanity in the presence of minors. 7. Sponsors and volunteers must be free of physical and psychological conditions that might adversely affect any

minor’s health, including, but not limited to, contagious disease. ARM reserves the right to request written statements of physicians or other necessary medical professionals should reasonable suspicion arise regarding physical and/or psychological conditions and their possible adverse affect on the sponsor or volunteer being able to perform required duties or possible adverse impact on minors.

8. Sponsors and volunteers will portray a positive role model for minors by maintaining an attitude of respect, loyalty, patience, courtesy, and maturity.

9. Sponsors and volunteers will be expected to act and react with Christian love and understanding in all situations. 10. Sponsors and volunteers will do everything in their power to avoid being put in a situation where they are alone with a

minor other than their own minor relative. 11. I understand that any violation of this code may be grounds for removal from participation in ministry to minors.

Page 16: Gate2013 Intern Application

TEAM MEMBER’S STATEMENT

The information contained in this application form is correct to the best of my knowledge. I authorize any references to give you any information, including opinions, which they may have regarding my character, medical condition and/or fitness for work with minors or the mentally handicapped. In consideration of the receipt and evaluation of this application by ARM, I hereby release any individual, church, youth organization, charity, employer, reference, or any other person or organization, including record custodians, both 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 compliance or any attempts to comply with this authorization. I waive any right that I may have to inspect any information provided about me by any person or organization identified by me or my references in this screening form. I agree to be bound by these policies and to refrain from unscriptural conduct in the performance of my services on behalf of ARM. I further state that I have carefully read all of the above and know the contents thereof; and sign this release as my own free act. This is a legally binding agreement which I have read and understand.

Print name: Date:

Signature:

The signature above represents my current legal name and any previously used names are listed below.

Additional names:

Print witness name: Date:

Witness signature: