Personal Info

Name:     Nick Name:

Permanent Address:

City:

State: Zip Code:

Home Phone:

Office/School Phone:
             

Fax:           E-mail address:

Temporary Address:

City:

State: Zip Code:

Dates at this address:

Social Security Number: Date of Birth: Sex:
Marital Status: Number of Children:

Education

School: Major Subjects: Years:
Degree Granted:

School: Major Subjects: Years:
Degree Granted:

Children Who Must Accompany You To Camp

Last Name: First Name: Middle Name:
Nick Name: Date of Birth: Sex:

Last Name: First Name: Middle Name:
Nick Name: Date of Birth: Sex:

Past Employment Experiences

Start and End Dates:     Employer: Address:     City:     State:     Zip Code:     Phone: Nature of Work:     Supervisor: E-mail:    

Start and End Dates:     Employer: Address:     City:     State:     Zip Code:     Phone: Nature of Work:     Supervisor: E-mail:

Camp Experience

Start and End Dates:     Employer: Address:      City:     State:     Zip Code:     Phone: E-mail: Position:

Start and End Dates:     Employer: Address:     City:     State:     Zip Code:     Phone: E-mail: Position:

References

Name: Address:
City:     State:    
Zip Code:     Phone:
E-mail:
How they know you: CS?:

Name: Address:
City:     State:    
Zip Code:     Phone:
E-mail:
How they know you: CS?:

Name: Address:
City:     State:    
Zip Code:     Phone:
E-mail:
How they know you: CS?:

Are you a US Citizen or a legal resident of the United States? Yes No

Have you ever been convicted of a crime, including sex related or child about violations? Yes No

If yes, please explain:

Church Activities

Branch Church:Regular Attendant Member?    Where?:

Sunday School:Regular Attendant Member?    Where?:

CS College Organization: Regular Attendant Member?    Where?:

What Church or CS Organization activities have you participated in?

Are you class taught?Yes No

If so, when and where does your Association meet?

Camp Interest

Which age group(s) (between ages 6 and 17) would you prefer to work with?:

What dates are you available?From: To:

What salary would you expect?

In the following list indicate your interest and ability to instruct the following activities by marking:
C = I am currently certified to teach this activity.
1 = I feel qualified and want to teach this activity.
2 = I am willing to teach this activity if asked to do so.
3 = I could assist another staff member in teaching this activity.
4 = I have no interest in or ability to teach this activity.

Archery	Arts & Crafts	Astronomy	Basketball	Boardsailing
Camping Skills	Canoeing	Dance	Drama	Drawing
Swimming	Horseback Riding	Kayaking	Mountain Biking	Space Explorers
Nature	Pottery	Ropes Course	Sailing	Soccer
Music	Fishing	Tennis	Video	Writing

List the other activities not mentioned above that you would like to teach:

List three activities that you would like to teach at camp and your experience and/or qualifications for each:

Activity:

Activity:

Activity:

Do you have any of the following Red Cross Certifications? Yes No

If so, indicate the date they expire:

Emergency Water Safety:
Lifesaving:
Water Safety Instructor:
Lifeguard Training Instructor:
First Aid:
CPR:
Other (please specify):

Do you have a valid driver's license? Yes No
State: License #

Please write a brief Biographical Sketch including any specialized training in camping and experience or training in other fields which might have a bearing on this application.

Please write a brief Goals Statement explaining why you want to work at Crystal Lake Camps, what contribution you think you can make at camp, and how you feel this service relates to your future plans.

By clicking 'submit,' 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 directors of the camp. I also understand that untrue, misleading, or omitted information herein may result in dismissal, regardles of the time of discovery by the camp.