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STREET:
CITY: STATE: ZIP:
CELL: LANDLINE:
HOME PHONE:
COLLEGE YEARS COMPLETED IN JUNE 2008: Choose One 0 1 2 3 4 5 6 7 8
COLLEGE MAJOR:
EMAIL ADDRESS:
MAIL SHOULD BE SENT TO? School: Home:
UNTIL WHAT DATE?
PRESENT OCCUPATION OR SCHOOL NOW ATTENDING:
STATE: NUMBER: EXPIRES:
Has your driver's license ever been suspended or revoked? Choose One Yes No
AGE on June 1, 2008: Choose One Under 18 18-20 21+
BIRTH DATE (OPTIONAL):
DO YOU HAVE RESERVATIONS ABOUT LIVING WITH PEOPLE WHOSE RACE, COLOR OR RELIGION MAY DIFFER FROM YOURS? Choose One Yes No
If yes, please describe:
ARE YOU INTERESTED IN OR WILLING TO WORK WITH "SPECIAL NEEDS" CHILDREN? Choose One Yes No
WHEN ARE YOU AVAILABLE FOR SUMMER EMPLOYMENT?
UNTIL WHEN?
HOW DID YOU LEARN OF CAMP SLOANE?
DO YOU SMOKE? Choose One Yes No
If yes, are you willing to forego smoking while at camp? Choose One Yes No
WILL YOU BE ABLE TO PERFORM THE ESSENTIAL FUNCTIONS REQUIRED OF CAMP STAFF? Choose One Yes No
Please mail or fax a cover letter, resume or a statement describing any other leadership experience, or additional information, to supplement your application to: CAMP SLOANE YMCA, ATTN: CAMP DIRECTOR, 124 INDIAN MOUNTAIN ROAD, LAKEVILLE, CT 06039-1950 - FAX: 860-435-2599
Why are you applying to Camp Sloane YMCA this summer?
DO YOU PLAY A MUSICAL INSTRUMENT? Choose One Yes No
If yes, which instrument do you play?
ARE YOU ABLE TO BRING IT WITH YOU TO CAMP? Choose One Yes No
REFERENCES: PLEASE PROVIDE THREE REFERENCES, NOT RELATIVES, BUT THOSE WHO KNOW YOU WELL AND CAN SPEAK TO YOUR EXPERIENCE WITH CHILDREN, YOUR CHARACTER, AND YOUR WORK ETHIC.
I hereby certify that all statements made by me are correct in this application. Permission is granted to Camp Sloane YMCA to solicit and investigate statements from any person and/or organization with regard to my personal history and prior employment. I understand that inclusion of false information are grounds for disqualification or subsequent release from employment. If employed, I will conscientiously abide by all camp rules and conditions of employment. I give permission to Camp Sloane YMCA to conduct a criminal background check, check my driving record, and check the sex offender registry. Having made application for employment with Camp Sloane YMCA, and desiring it to be informed of my ability, reason for leaving employment, character, reputation for honesty, responsibility, work habits, and any record of convictions, I hereby authorize it to investigate and to ascertain any and all information contained in this application.
Camp Sloane YMCA is an equal opportunity employer.