Employment Application

Please answer all questions. Type or print clearly.

Name and Address:

Last Name, First Name Middle Initial

Current Address, City, State and Zip

Phone: Email

Position Applying For______

Employment Desired ____FULL TIME ONLY ____PART TIME ONLY ____FULL-OR-PART TIME

Date available to

start______

Availability

Morning / Afternoon / Evening
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
TYPE OF SCHOOL / NAME OF SCHOOL / LOCATION / NUMBER OF YEARS COMPLETED / DEGREE & MAJOR
HIGH SCHOOL
COLLEGE
TRADE SCHOOL

Please list your work experience for the past five years beginning with your most recent job held. Attach additional sheets if necessary.

Name of Employer______

Address______

City______State______Zip Code______

Supervisor______Phone______

Job Title______Starting Salary______Final______

DatesFrom______To______Reason for leaving______

List your duties and responsibilities

Name of Employer______

Address______

City______State______Zip Code______

Supervisor______Phone______

Job Title______Starting Salary______Final______

DatesFrom______To______Reason for leaving______

List your duties and responsibilities

Name of Employer______

Address______

City______State______Zip Code______

Supervisor______Phone______

Job Title______Starting Salary______Final______

DatesFrom______To______Reason for leaving______

List your duties and responsibilities

May we contact your present employer _____YES_____NO

Have you ever been convicted of a crime? ____ Yes ____ No

Are there any felony charges pending against you? ____ Yes ____ No

The Leslie Science & Nature Center will conduct a criminal history file check for all new and returning employees to determine the existence of any arrest resulting in conviction. Please give dates, places, charges and disposition of all convictions and any other information about convictions you would like us to consider.

Do you have a Driver’s License _____YES_____ NO

Driver’s License

Number______State of Issue______

Expiration Date______

_____Operator_____Commercial (CDL)_____Chauffer

Have you been in any accidents during the past three years?

Have you had any moving violations in the past three years?

Are you over the age of 18? ______Yes ______No

Please list three references, other than family members:

Name Name

PositionPosition

CompanyCompany

AddressAddress

Phone Phone

EmailEmail

Name

Position

Company

Address

Phone

Email

The Leslie Science & Nature Centerreserves the right to terminate anemployee if it is discovered that they made false statements during the application process.

I certify that the responses on this document are true to the best of my knowledge. I agree that this information may be verified and references contacted by Leslie Science & Nature Center.

Electronic Signature Date

Summer Camp Educator Applicants-

Please answer the following questions in 300 words per question or less. When possible, use stories and examples from your work or past experiences.

  1. What inspired you to apply for a position as an LSNC Summer Camp Educator? What would you hope to learn or achieve in this role?
  2. LSNC camp is the first place that many campers walk in the woods, closely interact with live animals, or eat lunch outside. What challenges would you expect to encounter as a Summer Camp Educator, and how might you address them?
  3. Summer Camp Educators are responsible not just for leading camp, but also for planning educational camp activities, completing paperwork, and caring for camp buildings and materials. In addition, Summer Camp Educators work with and are responsible for the safety of all LSNC campers, ages 5-11. What do you anticipate would be the most challenging aspect of this job for you, and why?
  4. What is the point of summer camp? How do you see your role as a Summer Camp Educator?