4 - Form W-4

Complete this form in its entirety. Be sure to sign and date at the bottom.

1 - Contract

This is the official agreement between you and Camp NEOSA which includes how much you will be paid, what position you have been assigned, and what dates you have been hired to work. Please type your name in the box at the bottom and click “Submit”.

2 - Statement of Work with Children

This document affirms that you are legally qualified to work with children. Please sign under "Employee Signature”. Someone who is present with you must sign as “Witness” and include their address. You may NOT sign as a witness for yourself.

3 - Ohio IT-4

Section I: Complete this section. If you do not know your school district of residence and/or school district number, you can leave this blank.

Section II and III: Complete to the best of your knowledge.

Section IV: Be sure to sign and date.

5 - Ohio Unemployment Compensation Exclusion

Basically, you would not qualify for unemployment should you leave or be dismissed from Camp NEOSA. Read, sign and date at the bottom.

7 - National Media Code of Conduct

The Salvation Army enforces proper use of media including photos, videos, social media, and more. Read, type in your position from your contract, sign and date at the bottom.

8 - Background Check Release

We will conduct a background check on all employees. Sign and date. Type in your date of birth and social security number. If you are 17 or younger, a parent must sign and date at the bottom. You may NOT sign and date as your parent or guardian.

9b - Physician’s Examination

This needs to be completed for every staff member by a medical doctor or licensed nurse practitioner. Only the medication listed here can be brought to camp and administered by our nursing staff. It should match the medication listed on the health history. It must be signed and dated within 15 months of the start of camp.

9a - Health History Form

This online form collects information about your health including allergies, current conditions, and medications. If you are 17 or younger, a parent/guardian must complete this with you.

9c - Immunization Form

You can either write in your immunizations or use a print out that clearly shows your name.

9d - Picture of Insurance Card

Please upload a picture of the front and back of your insurance card. This will only be used in case of emergency. If you do not have insurance, please just let us know.

9e - Asthma Waiver

If your physician’s exam form lists that you have ever had asthma or respiratory illness, this waiver must be completed. If you are 17 or younger, your parent must sign this form.

9f - Immunization Exemption/Waiver

This is only required if you are not currently immunized. It must be signed by a parent or guardian if you are 17 or younger.

Age Specific Forms

If you have any questions about any of the paperwork, contact Emilee Evans at Emilee.Evans@use.salvationarmy.org