Camp Staff Application Form

Page 1

Full Name

First Name

Last Name

Application Status

New Applicant Returning Staff

If returning, what was your camp nickname?

If you are returning staff, which of our camps have you worked at before?

Camp Pine Ridge Camp Blue Lake Camp Sunrise Other

Working availability beginning on:

Through what end date?

What is your best e-mail address?

How often do you check your email?

Every day A few times a week Once a week Rarely

What is your permanent phone number?

Current address valid until:

What is your permanent address?

Street Address

City

State / Province

ZIP / Postal Code

What is your current address?

Street Address

City

State / Province

ZIP / Postal Code

Present occupation or year in school:

Referral Source

Referral - Job Fair/Flyer (Where?)

Referral - Newspaper (Which?)

Referral - Friend/Staff Member (Who?)

Referral - Internet (Which Site?)

Page 2

High school information - Name:

City:

State:

Please list any community college, university, or tech school you have attended:

City:

State:

Major/Area of study:

Start date

Highest grade completed:

Degree or credits:

Please list any other community college, university, or tech school you have attended:

City:

State:

Major/Area of study:

Start date

Highest grade completed:

Degree or credits:

Do you have the legal right to work in the United States?

Yes No

Do you hold a current US driver's license?

Yes No

If yes, please explain:

Do you know of any reason why you would not be able to perform the essential functions of the position you are applying for, with or without reasonable accommodation?

Yes No

Have you ever been convicted of a crime (other than a traffic violation)?

Yes No

If yes, please state the offense, date, and location. (A conviction record will not necessarily prevent rehiring.)

Page 3

Briefly describe why you think you are qualified for the position(s) you are applying for.

List any certifications you will have current during the season:

Other related training or skills (please indicate expiration date mm/dd/yyyy)

Briefly summarize community, school, or other experiences that will enable you to carry out the responsibilities of the position you are seeking. Describe your experience working with children, the purpose of the experience, your role, and the result.

Write 3-4 sentences about yourself: things you like, where you're from, where you go or went to school, fun facts, hobbies, or anything else you'd like to share.

Why are you interested in working/returning to work at a camp this summer?

What qualities or characteristics do you possess that would be needed to make a great camp staff member?

Working at a summer camp is difficult at times: your duties will include long hours, putting campers' needs first, and cleaning parts of the camp. How do you feel about these things, and why would you be good working in this kind of environment?

List three goals you have for this coming summer if hired.

Upload your resume.

Max 10 MB per file

Page 4

Employment history - Employer's name:

Address:

Phone number:

Position/Title:

Dates employed:

Major responsibilities:

Reason for leaving:

Supervisor's name:

Employer's name:

Address:

Phone number:

Position/Title:

Dates employed:

Major responsibilities:

Reason for leaving:

Supervisor's name:

Employer's name:

Address:

Phone number:

Position/Title:

Dates employed:

Major responsibilities:

Reason for leaving:

Supervisor's name:

Experience as a camper/staff member - Camp name & location:

Organization:

Position:

Years

Supervisor:

Experience as a camper/staff member - Camp name & location:

Organization:

Position:

Years

Supervisor:

Page 5

References

Reference name:

Reference phone number:

Reference e-mail:

Reference position title:

How long have you known this reference?

What is your relationship with this person?

Reference name:

Reference phone number:

Reference e-mail:

Reference position title:

How long have you known this reference?

What is your relationship with this person?

Reference name:

Reference phone number:

Reference e-mail:

Reference position title:

How long have you known this reference?

What is your relationship with this person?

Page 6

I understand that successfully completing a physical examination and having current immunizations are conditions of employment.

I agree

I understand that employment is contingent upon passing a criminal background check and drug test, and I authorize the camp to conduct such a check if necessary.

I agree

I certify that all information provided is true and complete. I understand that falsifying or significantly omitting any information may be grounds for dismissal if discovered later.

I agree

Signature

Sign here

Date

Thank you for your interest in joining our camp staff.

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Camp Staff Application Form

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