Full Name |
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Social Security Number |
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Email |
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Permanent Address |
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Permanent Phone |
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School Address |
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School Phone |
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Congregation & City |
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Dates Available From |
to
mm/dd/yyyy |
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At which camp are you applying?
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What type of position do you want?
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Salary desired?
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Do you meet or exceed any minimum
age requirements for that position?
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Can you perform the essential function of the job for which you have applied,
with or without reasonable accommodations?
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If you are hired, would you desire or need housing for any person(s) other than yourself at the camp?
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| Past Work History List most recent employer first |
Employer's Name |
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City |
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Phone |
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Dates of Employment |
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Responsibilities |
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Employer's Name |
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City |
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Phone |
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Dates of Employment |
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Responsibilities |
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Employer's Name |
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City |
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Phone |
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Dates of Employment |
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Responsibilities |
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| References Give names and addresses of three persons [not relatives] having knowledge of your character, experience, work habits, and ability. |
Name |
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Address & City |
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Phone |
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Name |
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Address & City |
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Phone |
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Name |
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Address & City |
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Phone |
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| Camp Experience Describe any camp experience (camper or staff) you have |
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| Education High School and Beyond |
High School |
Graduated?
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College/University |
Graduated?
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| 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. |
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| Please list any Camp Program Skill you might have |
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Do you hold any current certification in courses that would apply to summer camp?
(First Aid, Life Guarding, etc. Give expiration dates.) |
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| What contributions do you think you can make at camp? |
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| What contributions do you think a well-run camp can make to children? |
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Harassment The camp’s policy is to prohibit all forms of harassment by our employees. 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. The type of accusation and when it occurred will be evaluated by the camp before any decision is made.) |
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Explain
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| 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. The type of conviction and when it occurred will be evaluated by the camp before any decision is made.) |
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Explain
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| 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 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 in dismissal, regardless of the date of discovery by the camp. |
| Please initial:
Date
Invalid format.mm/dd/yyyy |
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