Can you perform the essential functions of the job for which you have applied, with or without reasonable accommodation? Yes No *

If you require accommodation, please specify:

If you are hired, would you desire or require housing for anyone other than yourself at camp? Yes No *

If so, for whom?

Have you ever been accused of, or involved in, an incident involving sexual or physical abuse of a child? Yes No *

Have you ever been convicted of any criminal offence? Yes No *

Are you currently subject to a police investigation? Yes No *

Are there any experiences in your background which are likely to negatively affect your performance as a staff member? Yes No *

If you answered yes to any of these questions, please explain in detail:

Do you have Health Insurance? Yes No *

If yes, please indicate name of Insurer & Policy #:

Do you have any health problems that could interfere with or impact upon your ability to fulfill your job responsibilities? Yes No *

If yes, please explain:

Do you have any allergies or asthma? Yes No

If Yes, please specify:

Are you on a medication regimen other than birth-control? Yes No *

If yes, please provide name(s) or medication and total daily dosages:

Do you have any dietary restrictions? Yes No *

If yes, please provide details:

Choice One: *

Choice Two: *

Choice Three: *

What contributions do you think you can make at camp? *

What is your best personal trait or characteristic?

What personality, trait or characteristic would you like to improve? *

Please write a brief biographical sketch, including specialized training in camping, and experience or training in other fields which might have a bearing on the position(s) for which you are applying. *

Are you available for an interview? Yes No *

If yes, please specify a location: