Staff Applications - Amity Acres Day Camp

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- Returning Staff Application

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New Staff Application

First Name (*)

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Last Name (*)

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Current Address (*)

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City (*)

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State (*)

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Zip Code

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Phone (*)

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Cell Phone (*)

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Permanent Address (*)

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City (*)

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State (*)

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Email Address (*)

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Alternate Email

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Are You lawfully authorized to work in the United States? (*)
Yes
No

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Do you hold a current driver's license? (*)
Yes
No

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Will you be at least 18 years of age by June 1, 2010? (*)
Yes
No

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Education

Name and Address of High School (*)

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Course of Study (*)

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Years Completed (*)

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Did you graduate? (*)
Yes
No

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Name and Address of College

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Course of Study

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List diploma or degree

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Years Completed

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Did you graduate college?
Yes
No

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Name and address of additional educational facility

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Other Course of Study

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List diploma or degree

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Years Completed

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Did you graduate?
Yes
No

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Record of Employment

Name and address of most recent employer

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Dates of Employment

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Describe the work you did

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Reason for Leaving

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Name and Phone Number of supervisor

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Name and address of previous employer #1

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Dates of Employment

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Describe the work you did

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Reason for Leaving

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Name and Phone Number of supervisor

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Name and address of previous employer #2

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Dates of Employment

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Describe the work you did

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Reason for Leaving

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Name and Phone Number of supervisor

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Name and address of previous employer #3

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Dates of Employment

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Describe the work you did

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Reason for Leaving

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Name and Phone Number of supervisor

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Camp Staff/Camper Experience

Please list your previous experience as a camper or camp staff. Include the year, position and camp name (if applicable). If not Amity Acres Day Camp include the name of the facility and its phone number. (*)

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Please list your previous experience as a camper or camp staff. Include the year, position and camp name (if applicable). If not Amity Acres Day Camp include the name of the facility and its phone number. (*)

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Please list your previous experience as a camper or camp staff. Include the year, position and camp name (if applicable). If not Amity Acres Day Camp include the name of the facility and its phone number. (*)

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Personal References

List three people who can make a statement regarding your work experience, character, and ability. Do not include relatives or fellow students. We must have exact contact information. These are the people to whom you will provide reference forms or the day camp website.

First Reference Name (*)

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First Reference Position/Company

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First Reference Phone Number (*)

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First Reference City/State

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Second Reference Name (*)

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Second Reference Position/Company

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Second Reference Phone Number (*)

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Second Reference City/State

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Third Reference Name (*)

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Third Reference Position/Company

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Third Reference Phone Number (*)

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Third Reference City/State

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Certifications

Do you hold any certifications? For example, CPR by Red Cross.

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Do you know of any reason why you would not be able to perform the essential functions of the job position for which you are applying with or without reasonable accommodations? (*)
Yes
No

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If yes, please describe.

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Have you ever been convicted of a crime? (*)
Yes
No

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If yes, please describe.

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Date of conviction and location

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Choose first choice for position (*)

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Choose second choice for position

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Choose third choice for position

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What age group are you interested in working with? (Hold the Control Key if selecting multiple options) (*)

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Select the weeks you are available to work.(Hold the Control Key if selecting multiple options)

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I hereby acknowledge that I have read and understand the above statements and that I voluntarily sign the application. (*)
YesNo
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I agree to begin the interview process by submitting this application with the understanding that if I am hired I am expected to attend STAFF TRAINING at a date to be determined soon. (*)
YesNo
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