Staff Application

Full Name:

First Name Last Name

Birth Date:

Month Day Year

Age:

Gender:

Address:

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

New/Returning:

School Attending in September:

Grade Entering:

Phone Number:

Area Code Phone Number

E-mail:

Father’s Name:

Father's Hebrew Name:

Father's Business Phone:

Area Code Phone Number

Mother’s Name:

Mother’s Hebrew Name:

Mother's Business Phone:

Area Code Phone Number

Home Phone:

Area Code Phone Number

Mobile Phone:

Area Code Phone Number

Available From:

Available To:

Social Security Number:

Position applying for:

State any special skills, talents & qualifications:

Dates:

Camp & Director:

Location:

Camper or Staff?

Dates:

Camp & Director:

Location:

Camper or Staff?

Date:

Camp & Director:

Location:

Camper or Staff?

Business/Administration:

bookkeeping/accountingcomputer/technicalcomputer/software

Please list:

Health/Safety:

Maintenance:

auto mechanicscarpentryelectricalplumbing

Food Service:

Name:

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number

Position

Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number

Position

Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number

Position

Dates:

Employer/Supervisor

Address & Phone

Nature of Work

Reason for Leaving

Dates

Employer/Supervisor

Address & Phone

Nature of Work

Reason for Leaving

Dates

Employer/Supervisor

Address & Phone

Nature of Work

Reason for Leaving

Do you have a valid driver’s license?

YesNo

State

Do you have a commercial driver’s license?

YesNo

Harrassment The camp’s policy is to prohibit all forms of harassment by our employees and/or volunteers. This includes sexual, racial, religious, and other forms of harassment. Have you ever been accused of harassment of any person including, but not limited to, workplace harassment? (Note; a prior accusation is not an automatic bar to employment/volunteering. The type of accusation and when it occurred will be evaluated by the camp before any decision is made)

YesNo

Please explain:

Criminal Record Have you ever been convicted of a crime, other than a minor traffic offense? If yes, please describe. (Note: a prior conviction is not an automatic bar to employment/volunteering. The type of conviction and when it occurred will be evaluated by the camp before any decision is made.)

YesNo

Please explain:

Date of application:

If applicable, what experience do you have, working with children?

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. Attach a separate sheet if necessary.

What contributions do you think you can make at camp?

What contributions do you think you a well-run camp can make to children?

I authorize investigation of all statements herein, including any checks of criminal records, 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/volunteer unless there is an agreement or law which alters that status. Furthermore, I understand that any agreement must be in writing and signed by the designated camp official. I also understand that misrepresentations or falsifications herein or in other documents completed or submitted by the applicant will result I dismissal, regardless of the date of discovery by the camp.

Signature:

Date:

All statements become part of any future employee personnel files.

Please mail completed application to Raizel at 2174 Hewlett Ave, Suite 100, Merrick, NY 11566
or Fax to 866-539-4748 or E-mail [email protected]

Staff Information

Certification and Camp Support Staff Skills

References

Past Work History