Permanent Address
Address A value is required.
City: A value is required. State: A value is required. Zip: A value is required.
Phone: A value is required.

Present Address (if different from permanent)
Address
City State Zip
Phone

Email:
A value is required.
Cell:

Age (as of 12/31/2012) (check one)
16-19
20+
Please make a selection.
Gender -- Male Female Please select an item.

MUST BE AT LEAST 16 YEARS OF AGE BY 12/31/2012 TO BE HIRED!!
LIFEGUARDS MUST BE AT LEAST 18 YEARS Of AGE BY 12/31/2012

IV. Personal References (NO RELATIVES)

1. Have you ever been convicted of a felony? -- No Yes

2. Have you ever had a professional license
or certificate revoked? -- No Yes

3. Have you ever resigned from a position as an alternative to disciplinary proceeding against you? -- No Yes

V. Objective
What type of position are you applying for?

With what age group do you prefer to work?

VI. Skills (Please fill out completely)

List current certifications
(First Aid, CPR, Lifeguarding, Water Safety, Coaching, etc.):

Below we have listed various camp skills.
Please place a "1" next to those activities you feel capable of organizing and teaching.
Place a "2" next to those activities which you enjoy and feel confident in assisting.

Arts & Crafts
-- 1 2 Ceramics
-- 1 2 Crafts
-- 1 2 Painting
-- 1 2 Woodworking
-- 1 2 Other (Specify)

Waterfront
-- 1 2 Boating (kayak/canoe/sail/row)
-- 1 2 Fishing
-- 1 2 Lifesaving
-- 1 2 Swimming
-- 1 2 Other (Specify)

Performing Arts
-- 1 2 Dance - Ballet
-- 1 2 Dance - Jazz
-- 1 2 Dance - Hip Hop
-- 1 2 Dance - Other
-- 1 2 Music – Instrumental
-- 1 2 Music – Vocal/Choral
-- 1 2 Theater Arts/Drama
-- 1 2 Other (Specify)

Outdoor Ed.
-- 1 2 Hiking
-- 1 2 Orienteering
-- 1 2 Overnight Camping
-- 1 2 Project Adventure/Challenge Course
-- 1 2 Other (Specify)

Describe interests, skills, or strengths that you would contribute to the camp. This may involve demonstrating, leading, or organizing activities involving that interest:
(Examples: cheerleading, ultimate frisbee, magic, other sports/talents/interest areas, etc.)