| STAFF APPLICATION |
| * First Name: |
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| * Last Name: |
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| * Email: |
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| * Social Security #: |
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| * Gender: |
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| * Position Applying For: |
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| * Address: |
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| * City: |
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| * State: |
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| * Zip Code: |
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| * Primary Phone: |
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| Secondary Phone: |
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| School Address: |
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| School City: |
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| School State: |
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| School Zip Code: |
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| School Phone: |
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| * How did you hear about us? |
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| * Where would you like to receive your mail? |
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| * Are you over 18? |
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| Background Information |
| * Do you have a drivers license? |
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| If so, which state: |
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| * Have you ever been charged with committing an act of physical, sexual, or any other type of child abuse? |
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| * Have you ever been convicted of a crime? |
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If the answer is Yes to any of the above questions, please explain:
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* Describe any interests or hobbies you have:
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* Why do you want to work at Camp Poyntelle Lewis Village?
(Please include any special skills, talents, work with children, etc.)
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* Please give three references that we can contact
(do not include friends or relatives)
Name / Relationship / Address / Phone |
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| Additional Information |
| * Have you previously been employed or completed an application for employment with Camp Poyntelle Lewis Village, Samuel Field Y, or any of it's programs? |
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| * Do you have any relatives currently employed at Camp Poyntelle Lewis Village, Samuel Field Y, or any of it's programs? |
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If yes to any of the above, please explain:
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| Educational & Occupational Background |
* Schools Attended
(HS & College)
Years / Degree / Major |
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* Previous Camp Employment:
Camp / Position / Years / Salary / Addr. & Phone |
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* Related Work Experience:
Employer / Duties / Years / Salary / Addr. & Phone |
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* Community Group Affiliation
(JCC, "Y", Youth Org):
Organization / Years / Involvement |
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| Skills and Experience |
| We would like to know about your skills in certain areas. Please read the following list of activities. Then, in the boxes below, list activities you are familiar with and activities that you can teach or lead. |
Athletics:
Softball
Basketball
Archery
Indoor Games
Soccer
Gymnastics
Golf
Hockey
Tennis
Volleyball
Baseball
Music :
Leading Songs
Instrument(specify)
Guitar
Piano
Other
Cultural Activities:
Oneg Shabbat
Israeli Dancing
Leading Services |
Waterfront:
WSI
Lifeguard
Lifeguard Trainer
Small Crafts Instr.
CPR Cert.
EMT
Sailing
Canoeing
Kayaking
Windsurfing
Swimming
Other Areas:
Computers/Tech
Newspaper
Typing
Photography (B/W)
Maintenance
Kitchen :
Cooking
Baking |
Arts & Crafts:
Ceramics
Wood Working
Sculpture
Copper Enameling
Dramatics :
Creative
Stage Craft
Costuming
Other
Outdoor Life:
Nature
Camp Craft
Outdoor Cooking
Camp Fires
Farming/Gardening
Overnight Hikes
Ropes Course |
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| * Familiar: |
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* Teach or Lead:
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| PLEASE READ THE FOLLOWING INFORMATION: |
| I certify that all the statements and information on this application are accurate and complete, and I understand that any employment offer is based upon the accuracy of this information. Any false statements, omissions or inaccuracies of this application will be just cause for my disqualification or dismissal.
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