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STAFF APPLICATION

Name:
Social Security #:
Date:

Camp Sloane
An Outdoor YMCA - A Place to Grow

COLLEGE ADDRESS:

HOME ADDRESS:

STREET:

STREET:

CITY: STATE: ZIP:

CITY: STATE: ZIP:

   

CELL: LANDLINE:

HOME PHONE:

   

COLLEGE YEARS COMPLETED IN JUNE 2008:

COLLEGE MAJOR:

EMAIL ADDRESS:

   

MAIL SHOULD BE SENT TO? School: Home:


UNTIL WHAT DATE?

PRESENT OCCUPATION OR SCHOOL NOW ATTENDING:

   

DRIVER'S LICENSE:

STATE: NUMBER: EXPIRES:

Has your driver's license ever been suspended or revoked?

AGE on June 1, 2008:


BIRTH DATE (OPTIONAL):

 

DO YOU HAVE RESERVATIONS ABOUT LIVING WITH PEOPLE WHOSE RACE, COLOR OR RELIGION MAY DIFFER FROM YOURS?

If yes, please describe:

ARE YOU INTERESTED IN OR WILLING TO WORK WITH "SPECIAL NEEDS" CHILDREN?

WHEN ARE YOU AVAILABLE FOR SUMMER EMPLOYMENT?

UNTIL WHEN?

HOW DID YOU LEARN OF CAMP SLOANE?

DO YOU SMOKE?

If yes, are you willing to forego smoking while at camp?

WILL YOU BE ABLE TO PERFORM THE ESSENTIAL FUNCTIONS REQUIRED OF CAMP STAFF?

EDUCATION

 
SCHOOLS/COLLEGES
DATES
MAJOR
DEGREE
1.) 
2.) 
3.) 

WORK EXPERIENCE

 
EMPLOYER
EMPLOYER TELEPHONE #
DATES EMPLOYED
1.) 
2.) 
3.) 

EXPERIENCE AS A CAMPER OR AS A CAMP STAFF MEMBER

 
CAMPER OR STAFF
CAMP NAME
ADDRESS
DATES
1.) 
2.) 
3.) 

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?

CURRENT CERTIFICATIONS - Please attach photocopies;
an additional $25/relevant certification is offered.

  CERTIFICATION EXPIRES   CERTIFICATION EXPIRES
1.)  3.) 
2.)  4.) 

AREAS OF EXPERTISE

INSTRUCTIONS: PLACE A "1" BEFORE ALL ACTIVITIES YOU ARE ABLE TO ORGANIZE/TEACH; A "2" IF YOU CAN ASSIST IN TEACHING THIS ACTIVITY; OR A "3" IF IT IS A HOBBY.

ADVENTURE

HIKING
MOUNTAIN BIKING
BACK PACKING
OUTDOOR COOKING
FIRE BUILDING
OVERNIGHTS
RAPPELLING
INITIATIVES
LOW ROPES
HIGH ROPES
OTHER

ARTS & CRAFTS

DRAWING
PAINTING
WOOD WORKING
TIE-DYE
SCULPTURE
CARTOONING
CANDLE MAKING
JEWELRY
CERAMICS
OTHER

ATHLETICS

ARCHERY
BASKETBALL
FIELD HOCKEY
FOOTBALL
GOLF
GYMNASTICS
BASEBALL/SOFTBALL
SOCCER
TENNIS
OTHER

AQUATICS

SWIMMING
DIVING
SNORKELING
CANOEING
CREW ROWING
ROW BOATING
WATER-SKIING
SAILING
WINDSURFING
OTHER

MEDIA ARTS

NEWSPAPER
COMPUTERS
PHOTOGRAPHY
YEARBOOK
RADIO STATION
VIDEO TAPING
OTHER

HORSEMANSHIP

ENGLISH
RING RIDING
TRAIL RIDING
HORSE
OTHER

NATURE

CONSERVATION
ANIMAL STUDY
PLANT STUDY
GARDENING
ECOLOGY
WEATHER
FISHING
TRACKING
ASTRONOMY
NATURE CRAFTS
OTHER

PERFORMING ARTS

DRAMA
MUSIC
DANCE (Type)
STAGECRAFT
MIME
THEATER GAMES
PIANO
OTHER

OTHER AREAS

   
OFFICE WORK
SPECIAL NEEDS
OTHER
KITCHEN
MAINTENANCE

DO YOU PLAY A MUSICAL INSTRUMENT?

If yes, which instrument do you play?

ARE YOU ABLE TO BRING IT WITH YOU TO CAMP?

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.

  NAME ADDRESS PHONE RELATIONSHIP
1.) 
2.) 
3.) 

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.


ELECTRONIC SIGNATURE: DATE:
(Type your full name in this box to accept this legally binding agreement.)

Camp Sloane YMCA is an equal opportunity employer.

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