Sacajawea Day Camp - Staff Applications

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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Summer 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, 2012? (*)
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 Sacajawea 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 direct to the day camp website to complete a reference.

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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GENERAL INFORMATION

Please describe why you would like to work at Sacajawea Day Camp. (*)

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Briefly describe yourself. (*)

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Rate yourself on the following qualities, on a scale of 1 - 10. 1 = Poor, 10 = Excellent

Patience (*)

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Sense of Humor (*)

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Motivation (*)

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Honesty (*)

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Common Sense (*)

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Flexibility (*)

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Self-Discipline (*)

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Resourcefulness (*)

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Time Management (*)

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Ability to Follow Directions (*)

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What do you imagine will be your greatest difficulty in camp? (*)

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POSITION INFORMATION

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? (Check all that apply.) (*)
3 & 4 year olds (Co-ed unit)
K - 1st grade
2nd - 3rd grade
4th - 5th grade
6th grade
7th - 8th grade

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Select the weeks you are available to work. (Check all that apply) (*)
Week 1: June 18 – 22, 2012
Weeks 2 – 4: June 25 – 29, July 2 – 6, July 9 – 13, 2012
Weeks 5 – 7: July 16 – 20, July 23 – 27, July 30 – August 3, 2012
Weeks 8 – 10: August 6 – 10, August 13 – 17, August 20 – 24, 2012

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Please list all weeks that you are available that have not been chosen above because you were not able to commit to a block of weeks.

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For Staff 18 and over: Would you be interested in working AM (7-8:30am) or PM (4-6pm) extended care?
Yes
No

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For Staff Members 16 yrs & older: Would you be able to work Thursday overnights? (*)
Campfire Only
Campfire & Overnight
Not old enough
Not able to

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If not able to, why?

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I am interested in being a counselor for the following: (*)
Week 2 : Cheerleading
Week 3 : Volleyball
Week 4 : Tennis
Week 5 : Golf
Week 7 : Frisbee
Week 9: Soccer
I am not interested.

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Please list any experiences related to the above programs.

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I am interested in being a couselor for the following: (*)
Week 2 : Fun-due
Week 3 : Cake Creations
Week 4 : Souper Bowl
Week 5 : Iron Chef Sacajawea
Week 6 : Sensational Snacks
Week 7: Cake Creations
Week 8 : Willy Wonka Fun Factory
Week 9: Breakfast Bonanza
I am not interested.

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Please list any experiences related to the above programs.

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I am interested in being a counselor for the following: (*)
Weeks 2 & 3 : Camp Program Aide Training
Weeks 4 & 5: Guard Start/CPA Training
Week 6: CPA Specialization Training
I am not interested.

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Please list any experiences related to the above programs.

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Please list the day(s) of the week/dates/times you are available for an in-person interview (spring break, etc.): (*)

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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 all MANDATORY STAFF TRAINING: choose ONE of the following weekends.. (*)
May 18th, 19th, and 20th
June 8th, 9th, and 10th

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List one thing you would like to learn about during Orientation. (*)

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Each staff member recieves 2 free staff logo t-shirts. Please select the size shirt you wish to recieve for this season. (*)

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The following are the staff sweatshirts which are available for purchase. The cost of each shirt is $25.00. These are the only sweatshirts which may be worn over camp shirts. All other sweatshirts may be worn but MUST be UNDER the staff t-shirt. Please mail payment (after receiving confirmation of being hired) for these shirts in the form of a check to 242 Adelphia Rd., Farmingdale, NJ 07727 Attn: Joan Basilotto

(*)

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PLEASE READ BEFORE SIGNING

We appreciate your interest in a position with the Girl Scouts of the Jersey Shore/Camp Sacajawea. If you have questions about signing the following statement, please ask the interviewer to explain.

STATEMENT OF APPLICANT

In an effort to attract the highest quality staff, I understand that as a part of the application process for employment with the Girl Scouts of the Jersey Shore, Inc. (GSJS), an extensive inquiry will be made concerning my prior employment, activities, character, and I fully consent to and authorize all such inquiries. In the event of my employment by GSJS, I will comply with all policies set forth in the personnel manual and with other policies established from time to time by the organization. I certify that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing that would, if disclosed, affect this application unfavorable. I understand and agree that any misrepresentation or omission of facts would exclude my being considered for employment or, after employment, would be cause for termination of employment with GSJS. I understand that a background check will be processed. I hereby acknowledge that I have read and understand the above statements and that I voluntarily sign this application by checking the accept box below.

(*)
Accept
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I hereby acknowledge that I have read and understand the above statements and that I voluntarily sign the application. (*)
Accept
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