Camp Hilltop Staff Application

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Staff Application

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If your interested in becoming a Camp Counselor, please fill out the form below :

Name

Gender

Male Female

Social Security Number

As of June 1, are you 18 or older:

Yes No

Date of Birth (Optional)

-- mm/dd/yy

Present Mailing Address

Address (cont.)

City

State/Province

Zip/Postal Code

Until what date can we send
mail to your present address:

-- mm/dd/yy

Phone

E-mail

Permanent Mailing Address

Address (cont.)

City

State/Province

Zip/Postal Code

Phone

Current occupation and/or school now attending:

Earliest Date you can begin work this summer:

-- mm/dd/yy

Latest date you can work this summer:

-- mm/dd/yy

Do you have the legal right to work in the United States:

Yes No

Position you are applying for:

Ages of children you prefer to work with:

EDUCATION:

High School:

Name of Institution:

Major Studies:

Dates of Attendance:

Degree Earned:

Date of Degree

Honors & Distinctions

College:

Name of Institution:

Major Studies:

Dates of Attendance:

Degree Earned:

Date of Degree

Honors & Distinctions

Graduate:

Name of Institution:

Major Studies:

Dates of Attendance:

Degree Earned:

Date of Degree

Honors & Distinctions

Additional training applicable to camp:

CAMP EMPLOYMENT EXPERIENCE

Name of Camp:

Location of Camp:

Dates Employed:

Your Duties:

Your Salary:

Director's Name & Telephone:

Name of Camp:

Location of Camp:

Dates Employed:

Your Duties:

Your Salary:

Director's Name & Telephone:

OTHER EMPLOYMENT EXPERIENCE

Name of Firm:

Address of Firm:

Dates Employed:

Your Duties:

Your Salary:

Supervisor's Name & Telephone:

Name of Firm:

Address of Firm:

Dates Employed:

Your Duties:

Your Salary:

Supervisor's Name & Telephone:

Name of Firm:

Address of Firm:

Dates Employed:

Your Duties:

Your Salary:

Supervisor's Name & Telephone:

INTERESTS & ABILITIES

Use the following rating system, place the appropriate number in front of those activities which reflect your talents and interest.

1 - You are qualified expert with teaching experience and could head the program.
2 - You are excellent in the activity, but with no teaching experience. Might be able to head the program.
3 - You feel qualified to be an assistant to the head counselor in this activity.
4 - You have done and are familiar with the activity, but are not qualified to teach.

LAND SPORTS:	TEAM: Basketball Field Hockey Floor Hockey Football Lacrosse Newcomb Rugby Soccer Softball Volleyball	INDIVIDUAL: Archery Fishing Go Carting Gymnastics, Floor Riding (Western/Eng) Tennis Mtn. Biking

WATER SPORTS:	Canoeing Kayaking Sailing	Swim Instructor Water Skiing Wind Surfing

VISUAL ARTS:	Basketry Candle Making Drawing Leather Craft Jewelry Rocketry Painting Puppetry	Paper Mache Photography Pottery Screen Printing Stain Glass Weaving Woodworking

PERFORMING ARTS:	THEATER: Acting/Drama Magic DANCE: Folk/Square Modern Jazz Aerobics	MUSIC: Piano (select from below) Guitar Song Leader

OUTDOOR LIFE:	TRIP CRAFTS: Back Packing Campcraft Fire Building Outdoor Cooking Ropes High/Low	NATURE & ECOLOGY: Animal Care Astronomy Ecology & The Life Cycle Reptiles

OFFICE:	WordPerfect Corel Other

KITCHEN:	Chef Asst. Cook Baker General Help

MAINTENANCE:	Carpentry Grounds Plumbing Painting

MISCELLANEOUS:	Bilingual What Languages? Tutoring What Subjects?	Camp Newspaper Computers Electronics Leadership Workshop New Games
OTHER ACTIVITIES:

I am MOST qualified in:

I am SECOND MOST qualified in:

I am THIRD MOST qualified in:

CERTIFICATIONS & LICENSES (check those you currently hold and give expiration dates):

QUESTIONS

What contributions do you believe you can make at Camp Hilltop?

Briefly describe the most significant experiences you have had working with children.

How do you think children might benefit from the camping experience?

What is your concept of a counselors responsibilities?

Are there any reasons you may have difficulty performing any of the essential functions of the job for which you have applied? Yes No

If yes, please explain:

Have you ever been convicted of a crime? Yes No

If yes, please explain:

Have you ever been convicted of child abuse or sexual abuse? Yes No

If yes, please explain:

REFERENCES

References are required for consideration of this application. Provide at least two, three if possible. Include each reference's name, address, and phone number below. Your references should be former or present employers, supervisors, persons who have seen you work with children. They should not be relatives or neighbors.

Reference Name:

Mailing Address:

Phone:

Relationship to you:

Reference Name:

Mailing Address:

Phone:

Relationship to you:

Reference Name:

Mailing Address:

Phone:

Relationship to you:

AGREE

I authorize investigation of all statements herein and release the camp and all others from liability in connection with same. I understand that untrue, misleading or omitted information herein (including any attached resumes, other written material or information provided during interviews) may result in dismissal, regardless of the time of discovery by the camp.

I AGREE

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