Cooking Staff Application
This Application is
only
to be used by Staff volunteering to cook at GLBC
Staff Information
First Name
Middle Name
Last Name
Date of Birth
Phone Number
Street Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Driver's License Number
Email Address
Name of Organization you will be cooking for
Day of the week you will be cooking
What shift will you be working: Breakfast, Lunch, Dinner, of All Day
Name of your point person
Have you ever been
convicted of any thing other than a minor traffic violation
I authorize Great Lakes Burn Camp, Inc. to conduct a background check with the State Police and/or appropriate authorities for the purpose of determining my suitability for volunteer staff with Great Lakes Burn Camp, Inc.
Initials
Today's Date
PO Box 6189, Jackson MI 49204-6189 - 1-800-989-2571