Staff Application

Please Fill Out & Complete ALL Fields
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General Information

Emergency Contact Information

In event of emergency, contact:

Dates of Availability:

For what position are you applying? Cabin Counselor Athletics Counselor Waterfront Staff Adventure Staff Travel Counselor Medical Staff Activity Specialist Food Service Maintenance Office/Admin Weekend Counselor Other

If "Activity Specialist", specify which activity area:

If "Other", list other:

How did you learn about summit camp?
Online Newspaper Former Staff Who? Other:

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

*"reasonable accommodation" refers to the need for assistance of any type in order to perform the essential functions of your position.

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

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

Are there experiences in your background which are likely to negatively effect your performance as a camp counselor? Yes No

Are you currently a student? Yes No

If so, indicate name of school, major and minor areas of concentration, years completed, projected date of graduation and degree expected:

Are you currently employed? Yes No
Select one Full Time Part Time Employer:
Job Title:
Duties:

Do you smoke? Yes No

Do you have a Driver's License? Yes No

Is it a Commercial License? Yes No

Chauffeur's License? Yes No

Do you have experience in driving 15 passenger vans? Yes No

Trucks? Yes No

Do you have health insurance? Yes No

Please indicate name of Insurer & Policy #:

Please describe your experience in working with "Special Needs" populations. We are particularly interested in any experience you may have had with children classified as Learning Disabled/A.D.D./or Behavior Disordered. Indicate length of time, day/residential experiences, and levels of disability.

Medical Information

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

If so, please explain:

Do you have allergies or asthma? Yes No

Please specify:

Are you on a medication regimen other than birth-control? Yes No
If so, please provide name(s) of medication and total daily dosages:

Describe any dietary restrictions:

Qualifications/Certifications

Check only if you have current certification in the following and indicate expiration date.

In the following list, chose "1" for those activities you can organize and teach as an expert; "2" for those activities in which you can assist in teaching; and "3" for those which are just your hobbies; "C" for those in which you have current certification.

Which of the above areas are you most interested in working at camp?

(List in order of choice)
1.
2.
3.

List any awards, certificates & experience relating to your area of interest:

Working with children is what camp is all about! Please give careful thought and consideration to these questions. We consider these replies very important. 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?

Rate yourself on the following qualities: (1-10) 1=poor 10=excellent

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
Where?

Past Employment

Employer One:

Employer Two:

Employer Three:

Employer Four:

Indicate any employer you do not wish us to contact and the reason:

Camp Experience (as camper or staff)

Camp One:

Camp Two:

Camp Three:

Camp Four:

References

(Give names and addresses of 3 persons, no friends or relatives, having knowledge of your character, experience, and ability)

Optional information

Date of Birth: Sex: Female Male

I authorize investigation of all statements herein and release the camp and all others from liability in connection with same. I understand that, if employed, I will be an at-will employee and that any agreement to the contrary must be in writing and signed by the director of the camp. I also understand that untrue, misleading, or omitted information herein may result in dismissal, regardless of the time of discovery by the camp. NOTE: By clicking on the submit button, you are, in essence, providing your signature and stating that you agree to the above terms.