Summer Staff Application Please Type or Print

Return Application to: Spring Heights Education Center2067 Barrcut Rd.Spencer, WV 25276 Or email to:

(304) 927-5865

PROFILE
Date of Application:
Name: / Date of Birth:
Permanent Address: / Phone:
Email:
School/Business Address: / School/Business Phone:
Position(s) Applied For:
Counselor / Program Assistant / Lifeguard / Maintenance / Kitchen
Dates Available: FROM TO / Salary Desired:
Are you available for an interview? / Where?
Are you a citizen of the United States? / YES / NO / If no, are you authorized to work in the U.S.? / YES / NO
Have you ever worked here before? / YES / NO / If so, when?
Have you ever been convicted of a felony? / YES / NO / If yes, explain
Church Name and Address: Pastor:
Recent Involvement at Church:

Education

Years / School / Major / Degree Granted

Past Employment(List previous two summers or years)

Dates / Employer / Address/Telephone / Nature of Work / Supervisor / Reason for Leaving

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CAMP EXPERIENCE
Dates / Camp / Address/Telephone / Director / Camper or Staff?

In the following list, put the numeral “1” before those activities you can organize and teach as an expert; “2” before those activities in which you can assist in leading; and “3” before those which are just your hobby.

Adventure/Challenge
___ Climbing/Rappelling
___ Ropes Course
___ Spelunking
___ Cycling
Arts and Crafts
___ Basketry
___ Ceramics
___ Jewelry
___ Leather Work
___ Macramé
___ Metal Work
___ Nature Crafts
___ Painting
___ Sketching
___ Weaving
___ Woodworking / Camp Craft/Pioneering
___ Camp craft
___ Hiking
___ Orienteering
___ Outdoor Cooking
___ Overnight
___ Mountaineering
___ Min. Impact Camping
Drama
___ Creative
___ Play Directing
___ Skits and Stunts
Music
___ Lead Singing
___ Instrument(List Below)
______
______/ Nature
___ Animals
___ Astronomy
___ Birds
___ Conservation
___ Flowers
___ Forestry
___ Insects
___ Rocks & Minerals
___ Trees & Shrubs
___ Weather
___ Gardening
___ Animal Care
Sports
___ Baseball
___ Basketball
___ Fishing
___ Informal Games / ___ Riding
___ Soccer
___ Softball
___ Tennis
___ Track & Field
___ Volleyball
___ Wrestling
Waterfront Activities
___ Canoeing/Kayaking
___ Diving
___ ARC/WSI
___ ARC/EWS
___ BSA/Aquatic Instructor
___ YMCA/Lifeguard
___ Rowing
___ Sailing
___ Swimming
___ Rafting / Miscellaneous
___ Standard First Aid Cert.
___ Advanced First Aid Cert.
___ CPR
___ Campfire Programs
___ Carpentry
___ Evening Programs
___ First Aid
___ Storytelling
___ Word Processing
___ Worship Services
___ Language
___ Bible Study
___ Photography
___ Darkroom
___ Newspaper

What talents do you have that will be an asset to the camp program?

______

What special training or experience do you have for this position?

______

REFERENCES (3 persons unrelated to you that have knowledge of your character, experience, and ability)
Name / Address / Telephone

I authorize investigation of all statements herein and release Spring Heights Education Center and all others from liability in connection with the 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 director of the camp. I also understand that untrue, misleading, or omitted information herein may result in dismissal, regardless of the time of discovery by the camp.

Signature ______All statements become a part of any future employee personnel files.

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