Name * First Name Last Name Date of Birth * MM DD YYYY Today's Date * MM DD YYYY T-Shirt Size Social Security Number * Phone * (###) ### #### 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? REFERENCES Reference #1 Name * First Name Last Name Reference #1 Relationship To You * Reference #1 Phone * (###) ### #### Reference #1 Email Reference #1 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Reference #2 Name * First Name Last Name Reference #2 Relationship To You * Reference #2 Phone * (###) ### #### Reference #2 Email Reference #2 Address Address 1 Address 2 City State/Province Zip/Postal Code Country Reference #3 Name * First Name Last Name Reference #3 Relationship To You * Reference #3 Phone * (###) ### #### Reference #3 Email Reference #3 Address Address 1 Address 2 City State/Province Zip/Postal Code Country EDUCATION Name Of High School High School Address Address 1 Address 2 City State/Province Zip/Postal Code Country First Date Of Attendance Last Date Of Attendance Did You Graduate? Yes No If "Yes" What Was The Date Of Your Graduation Did You Attend College? Yes No If "Yes" What Was The Name Of Your College? College Address Address 1 Address 2 City State/Province Zip/Postal Code Country First Date Of College Attendance Last Date Of College Attendance Course Of Study Or Degree/Major Did You Graduate? Yes No If "Yes" What Was Your Graduation Date? EMPLOYMENT HISTORY Employer Job Title Beginning Of Employment MM DD YYYY End Of Employment (Or Current Date If Still Employed) MM DD YYYY Describe Work/Duties Reason For Leaving Supervisor's Name First Name Last Name May We Contact This Employer? Yes No If "Yes" What Is This Employer's Phone Number (###) ### #### Employer Job Title Beginning Of Employment MM DD YYYY End Of Employment MM DD YYYY Describe Work/Duties Reason For Leaving Supervisor's Name First Name Last Name May We Contact This Employer Yes No If "Yes" What Is This Employer's Phone Number (###) ### #### SKILLS/TRAINING "I am skilled in ____________ enough to practice and teach _______________" Complete the following survey by inserting the specified topic into the blanks in the proposed statement above. Archery Strongly Disagree Disagree Neutral Agree Strongly Agree Arts & Craft Strongly Disagree Disagree Neutral Agree Strongly Agree Camping Strongly Disagree Disagree Neutral Agree Strongly Agree Journalism Strongly Disagree Disagree Neutral Agree Strongly Agree Canoeing Strongly Disagree Disagree Neutral Agree Strongly Agree Cheerleading Strongly Disagree Disagree Neutral Agree Strongly Agree Dance Strongly Disagree Disagree Neutral Agree Strongly Agree Drama Strongly Disagree Disagree Neutral Agree Strongly Agree Fire Building Strongly Disagree Disagree Neutral Agree Strongly Agree First Aid Strongly Disagree Disagree Neutral Agree Strongly Agree Fishing Strongly Disagree Disagree Neutral Agree Strongly Agree Sports & Games Strongly Disagree Disagree Neutral Agree Strongly Agree Hiking Strongly Disagree Disagree Neutral Agree Strongly Agree Navigation Strongly Disagree Disagree Neutral Agree Strongly Agree Outdoor Cooking Strongly Disagree Disagree Neutral Agree Strongly Agree Poetry/Writing Strongly Disagree Disagree Neutral Agree Strongly Agree Rifelry Strongly Disagree Disagree Neutral Agree Strongly Agree Songs & Music Strongly Disagree Disagree Neutral Agree Strongly Agree Swimming Strongly Disagree Disagree Neutral Agree Strongly Agree Check Any Certifications You Have (Check All That Apply) CPR Certification First Aid Certification Lifeguard's Certification List Any Other Skills, Training, or Certifications You Have In Detail Thank you! New Staff Application
