Name * First Name Last Name Date * MM DD YYYY Date of Birth * MM DD YYYY Position Desired T-Shirt Size * Do You Have A White, Collard Camp Niwana Staff Shirt * Yes No Social Security Number * Phone Number * (###) ### #### Alternate Phone (###) ### #### Email * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Are You At Least 18 Years OId? * Yes No Do You Have A Valid US Driver's License? * Yes No If "Yes" Enter You Driver's License Number * Are You A Citizen of the Unites States? * Yes No If "No" Do You Have Legal Authorization to Work In This Country? * Yes No Have You Been Convicted of a Crime? * Yes No If "Yes" For What Offense? When? Where? Please Explain In Detail Below Emergency Contact * First Name Last Name Emergency Contact Phone * (###) ### #### What Is Your Emergency Contact's Relationship To You? Are You Applying To Work For A Camper's Registration Fee? Yes No If "Yes" What Is The Camper's Name First Name Last Name If You Are Applying To Work For A Camper, What Is The Camper's Relationship To You? Background Check * I give permission for Camp Niwana to run a background check on my previous employment and criminal history. I give permission I do not give permission Thank you! returning staff application
