Seasonal Employment Application

Cabin & Program

Personal Information Please fill out each box completely and neatly.

Name (First, Middle, Last) / Social Security Number (required) / Date of Birth
Cell Phone Number / Email Address / Emergency Contact (Name/Phone)
Permanent Street Address / City / State & Zip Code
Current School/College / Course of Study & Year / Position Applying For

General Information Please answer each question and understand that no specific answers preclude your consideration for a position.

 Are you fully available from Saturday, June 15 until Saturday, August 18, 2013? Yes No

If no, what dates are you unavailable and why?

 Camp is very active environment and at the mercy of weather, insects, and nature. Staff members have limited personal time and supervise campers at all times through site, sound, and action. Do you have any physical or emotional conditions which preclude your full participation in camp? Yes No If yes, please provide a brief explanation.

 Camp Susan Curtis hires positive role models who can understand and interpret our mission and values. We follow a set of guidelines that puts the emotional and physical safety of our campers first. Are you prepared to be a positive role model and support our mission? Yes No

If no, what will hold you back?

 Camp Susan Curtis has a zero tolerance policy for alcohol and illegal drugs. Prescription Drugs are permitted only under the supervision of the Camp Health Care Manager. We are a TOBACCO FREE environment. Are you prepared to follow these policies at all times? Yes No

If no, what will hold you back?

 Camp Susan Curtis will conduct a background check through either a state or national agency on all applicants including the National Sexual Offender Registry. Have you ever been convicted of a crime, other than a minor traffic violation? Yes No

If yes, please provide a brief explanation with date and location.

 Camp Susan Curtis prohibits all forms of harassment by or to our employees including sexual, racial, religious, and other forms. Have you ever been accused of harassment of any individual including, but not limited to, workplace harassment? Yes No

If yes, please provide a brief explanation with date.

 Are you permitted to carry a concealed weapon in the State of Maine? Yes No

Employment Experience You may attach a resume for this section

Employer 1 / Position / Dates/Reason For Leaving
Employer 2 / Position / Dates/Reason For Leaving
Employer 3 / Position / Dates/Reason For Leaving

Community Service/Volunteer Experience You may attach a resume for this section

Project/Service 1 / Position / Supervisor (Name & Phone)
Project/Service 2 / Position / Supervisor (Name & Phone)

Written Responses Please attach a separate sheet of paper with responses.

  1. Knowing the mission of Camp Susan Curtis, what has inspired you to work here and what do you see as a potential challenge and/or reward to this kind of summer work?
  2. What lasting emotional or physical impact do you think a summer camp experience can have on a camper and/or a family?
  3. As a member of the staff team, what would be a positive contribution you would make and a challenge you

would bring (do you have a quirk, personal challenge, or weakness)?

  1. Talk about one or two goals and/or experiences you would hope to personally gain from a summer experience with us.
  2. Talk a little bit about what motivates you and how you persevere through a challenging situation.

References

Attached you will find a reference form. Please fill out the top section entitled Staff Information, make 2 additional copies and then forward by mail, email, or in person to 3 References. Please use teachers, coaches, resident advisors, or employers rather than friends or family members. References should return the forms to Camp Susan Curtis by mail or email.

Certifications

Please check any certifications you hold that will be valid through the Camp season and attach a copy.

 / Certification / Organization /  / Certification / Organization /  / Certification / Organization
First Aid / Boating / WSI
CPR/AED / License / Teaching
Lifeguard / Ropes / Other

Camp Skill Assessment

 Please place a T next to the skills/activities you feel confident in organizing/teaching/leading.

 Please place an A next to the skills/activities you feel confident in assisting with.

 Please leave blank the skills/activities that do not apply to either category.

Creative Arts:

_____General Arts & Crafts_____Fine Arts_____Pottery

_____Jewelry_____Drama/Theater Arts_____Written Word

_____Dance (Style: ______)

_____Music (Type: ______)

Environmental Adventures:

_____Hiking_____Orienteering_____Wetlands Study

_____Plant Identification_____Wildlife Identification_____Insect Identification

_____Gardening_____Backpacking_____Nature Games

_____Outdoor Cooking_____Conservation_____Leave No Trace

R.O.C.K. (Ropes & Outdoor Challenges for Kids):

_____Cooperative Games_____Low Ropes Course_____Rock Climbing

_____Group Initiatives_____High Ropes Course_____Mountain Biking

Sports & Games:

_____Archery_____Basketball_____Baseball/Softball

_____Floor Hockey_____Field Games_____Fitness Activities

_____Health & Nutrition_____Volleyball_____Soccer

Waterfront:

_____Shallow Water Games_____Deep Water Games

_____Beginner Swim Lessons_____Advanced Swim Lessons

_____Boating (Type: ______)

_____I am fearful of water_____I am not a good swimmer but don’t mind the water

Program Area Rankings:

Please rank from 1 to 5 the Programs you are most interested in with 1 being the highest level of interest and 5 being the least amount of interest. This is interest…not skill.

_____Creative Arts_____R.O.C.K. (Ropes & Outdoor Challenges for Kids) _____Waterfront

_____Enviro-Adventures_____Sports & Games

Age Group Ranking:

Please rank from 1 to 3 the Age Group you are most interested in with 1 being the highest level of interest and 3 being the least amount of interest.

_____3rd/4th grade (ages 8-9)_____5th/6th/7th grade (ages 10-12)_____8th/9th/10th (ages 13-15)

Please list any other Interests or Talents that you would be willing to share at Camp.

Staff Interview Dates

Please indicate below what dates or times would potentially be best for you if you are invited to move forward in the process. Interviews are group participation and take place in the Portland Office.

Sunday, March 24 (1:00-3:30) Saturday, April 6 (10:00-12:30) Either

Signature of Understanding

I understand that:

  • If I have any questions regarding this application or the following statement, I should ask them of the Director or interviewer prior to signing.
  • Camp Susan Curtis encourages people of all ethnic or national origin, color, religion, sex, or handicap to apply for a summer position. No question on this application is intended to secure information to be used for discrimination.
  • The completion and submission of this application does not guarantee an interview or employment.
  • Employment is conditioned upon submitting an approved health history showing, among other things, that all required immunizations are up to date.
  • Employment is conditioned upon submitting appropriate identification to prove that I am a legal worker (pursuant to the Immigration Reform and Control Act of 1986).
  • If I am hired, my employment with Camp Susan Curtis will be seasonal and “at will” and may be terminated by Camp Susan Curtis immediately without prior notice. I understand that no documents or statements of the Foundation will constitute a contract of employment that in any way limits the Camp Susan Curtis’ right to terminate employment at will unless specifically put in writing by the Director.
  • Without limiting in any way the at-will statements of my employment if I am hired, I understand that if any of the statements on this application are untrue, I may be immediately discharged.
  • I am authorizing an investigation of all statements herein and release Camp Susan Curtis and all others from liability in connection with same.
  • I am authorizing Camp Susan Curtis to request information from any law-enforcement agency, pertaining to any conviction (s) I might have had for violations of state or federal laws, including but not limited to convictions for crimes upon children.
  • I am authorizing Camp Susan Curtis to request information to process a Motor Vehicle Report through the camp insurance company.
  • By signing I hereby acknowledge that I have read and understand the above statements and information that has been provided.

Applicant Signature / Date