CAMP CLAPHANS APPLICATION

Date of Application: ______

Personal Information

Name: ______Social Security Number: _____-____-______

Present Address: ______

(street) (city)(state) (zip code)(Phone number)

DOB: ______Age: ______Year in School/ Occupation: ______

E-mail: ______

How did you learn about this camp position? □Friend □ Career/ job fair □ Ad □Other ______

Have you ever been convicted of a crime, other than a traffic violation? □ Yes □No

If yes, please state offense, date and location: ______

Position desired:

□ Unit Leader□Unit Assistant

(Paid Position)(Must be available all 5 weeks +training) (Volunteer Position)(Must be available for training)

□ Either PositionT-Shirt Size:

Certifications and Camp Support Staff Skills: From the following list, please check those items in which you have experience and skills. Attach a copy of your certifications for those you hold current certification.

□ CPR□ First Aid□ Food Handlers Permit

□ Other Pertinent Skills (list):□ Basic Lifeguard□ Small Craft

______□ EMT□ Archery

______□ RN□ Crafts

______□ LPN□ Horse

□ Other□ Waterfront

Camp Program Skills: Please list programs you can teach or lead comfortably (ex. Photography, dance, nature walks, drawing, painting, storytelling, etc.)

Do you know sign language?□ Yes □ No

Education

Name or School (High School, Vo-Tech, College) Major Subject YearDegree

Volunteer History

Dates: begin/ endEmployerTitlePhone Supervisor Name

Past Work History

Dates: begin/ endEmployerTitlePhone Supervisor Name

List any employer you do not wish us to contact, and the reason:

Camp Experience

DatesCampSponsoring OrganizationLocationCamp Director Staff Position

What contributions do you think you can make at camp?

How do you think a camping experience can benefit a child?

Staff Training

Required staff training is Monday June 4that 8am to Thursday June 7th at 4pm this is a full overnight experience at Camp ClapHans. Are you available for this training? Yes or No

Camp Sessions:Available

Session #1: Sunday June 10th to Wednesday June 13th □ Yes□ No

Session #2: Sunday June 17th to Wednesday June 20th □ Yes□ No

Session #3: Sunday June24th to Wednesday June 27th □ Yes□ No

Session #4: Sunday July 8thto Wednesday July 11th□ Yes□ No

Session #5: Sunday July 15rd to Wednesday July 18th □ Yes□ No

Do you have other obligations that limit your availability for this summer? ______

References List three persons, not relatives, who have knowledge of your character, experience, work habits and ability.

NameEmail AddressTitlePhone