New Staff Application Form 2013

Please note: * indicates required field

General Information

*Name
*Birthdate
*Email Address
*Gender

School/Temporary Address

Address
City
State
Zip (Postal Code)
Country
Phone (with area code)

Home/Permanent Address

Address
City
State
Zip (Postal Code)
Country
Phone (with area code)
Please mail info to my:
Cell Phone (with area code)
Social Security #

Driver's License Information

State
Number

Education

School
Level
Major/Degree

School
Level
Major/Degree

Camp Activities

At Kamaji staff members come with a wealth of great skills and experiences. For our information, on a continuum of 1 - 3, please identify for all activities listed below as follows:

3 = those you are highly skilled in

2 = those you are experienced in

1= those you have participated in

Please leave blank those skills and experiences you do not possess.

ADVENTURE ACTVITIES
Climbing Wall
Climbing/Rappelling
ARTISTIC AND CREATIVE ACTVITIES
Painting
Drawing
Cartooning
Calligraphy
Print Making
Jewelry Making
Paper Making
Basketry
Paper Mache
Etching
Mosaics
Batik
Silk Screening
Ceramics
Kiln Operation
Potter's Wheel
Clay Work
Sculpture
Photography
Dark Room Experience
Enlarger Experience
Printing/Developing
DANCE AND AEROBICS
Choreography
Hip/Hop
Latin (Meringue, Bachata and/or Cha-cha-cha)
Salsa
Stomp
Line-Dancing
Dance Team
Cheerleading
Aerobics
Step Aerobics
Yoga
Pilates
Circuit Training
Cardio-Kickboxing
I can supply music
EQUESTRIAN SPORTS
English
Western
Dressage
Jumping
Trail Rides
Horse Care
Stable Hand
Stable Management
I have experience teaching riding
LAND SPORTS
Tennis
Tennis Coaching/
Teaching Experience
Archery
Biking
THEATER ARTS
Directing
Screen Writing
Script Editing
Improvisation
Clowning
Musicals
Acting Techniques
Mime/Pantomime
Singing
Broadway Revues
Stage Blocking
Stage Combat
Set/Scenery/
Prop Design and Construction
Stagecraft
Costuming
Theater Makeup
Acting and Stage Performance
I can supply scripts
WATER SPORTS
Swim Instruction
Canoeing
Kayaking
Sailing
Waterskiing
Windsurfing
Motor Boat Driver
Fishing
Paddle-Boarding (Stand Up Paddling)
WILDERNESS TRIP LEADING
Outdoor Living Skills
Outdoor Cooking
Canoeing
Kayaking
Biking
Orienteering
Hiking
Climbing/Rappelling

Support Positions

Please check all that apply:

FOOD SERVICE Chef/Lead Cook
Assistant Cook
Food Prep
Salad Bar Prep
Kitchen Management
Foodservice Menu Planning
Kitchen Clean-Up
Dishwashing
Food Handler's Permit/Certification
MAINTENANCE Electrical
Carpentry
Plumbing
Painting
Landscaping
Chain Saw Use
Lawn-Mowing/Weedwacking
Auto Mechanics/Maintenance
Janitorial
Housekeeping
Driving While Towing Trailers
OFFICE Executive Assistant
Administrative Assistant
Computer Literate
Current and Valid Driver's License
15 Passenger Van Driving Experience
Computer Processing Experience
WordPerfect
Excel
Power Point
Microsoft Word
Quick Books
Adobe Photoshop
Email Management
Scrapbooking
Photocopying
Bookkeeping
Accounting
Petty Cash Management
Digital Photography
Digital Camera Use
Video Camera Use
MEDICAL Nursing-RN
Nursing-EMT
Physician-MD
3rd Year B.S.N Student
4th Year B.S.N Student
MISCELLANEOUS Story Telling
Team Building
Play a musical instrument (please list all)


Speak a foreign language fluently (please list)


Tutoring


Other (please list other talents, i.e. juggling, lip-synching, standing on head, etc. )

Certifications

Some positions (including Waterfront, Wilderness Trip Leaders, Riding, Ropes Course, Climbing Wall and Medical positions) require various certifications. Certification is not a pre-requisite for any position as we often provide several certification classes for those who need them ~ these would be offered at camp in early June prior to staff training.

Check off any of following certifications you currently hold and in the box below each list exact title of certification, certifying organization, and expiration date of certification (i.e., Lifeguard Training (LGT), American Red Cross, month/year of expiration)

Lifeguard Certification


Water Safety Instructor (WSI) Certification


Adventure/Challenge (Climbing Wall/Ropes Course) Certification


Certified Riding Instructor


National Archery Association Certification


Small Craft (Watercraft, Small Boat, Kayak, Canoe, Sailing) Certification


CNA (Certified Nursing Assistant)


EMT


CPR


First Aid Certification (including Wilderness First Aid, First Responder, etc.)
Given the skills, experiences and certifications that I have checked off/listed above, the camp positions I feel most qualified to apply for include:
Cabin Counselor, teaching the following activity(ies)
(Choose activity — in order of preference 1, 2 and/or 3 — from drop down box)
(1)

(2)

(3)

AND/OR

Wilderness Trip Leader
Nurse
Nursing Assistant
Cook
Assistant Cook
Kitchen Assistant (Dishwashing, Clean-Up)
Camp Driver
Maintenance
Office/Administrative Assistant

Describe your teaching experience, qualifications gained and personal standard of proficiency attained in connection with your responses under ACTIVITY CHOICES/SPECIFIC POSITION listed above. If you are applying for a position in the Office/Camp Driver, Maintenance/Housekeeping, Kitchen or Nursing areas, please indicate professional positions held, certifications, training and/or experience.

First Choice


Second Choice


Third Choice

Previous Camp Experience

Previous camp experience is not necessary in order to be hired at Camp Kamaji. But if you have attended or worked at a summer camp in the past, we would like to learn more.

1.
Camp Name
Address (City and State Sufficient)
Website (if known)
Position at Camp
if Staff Member
Years Attended/Worked
2.
Camp Name
Address (City and State Sufficient)
Website (if known)
Position at Camp
if Staff Member
Years Attended/Worked
3.
Camp Name
Address (City and State Sufficient)
Website (if known)
Position at Camp
if Staff Member
Years Attended/Worked

Employment History

If you have been employed in the past, please list your three most recent employers:

1. Employer Name/Company, Address (City/State sufficient) and Telephone Number (if available)
Employment Dates: Begin/End
Your Position/Nature of Work/Responsibilities
2. Employer Name/Company, Address (City/State sufficient) and Telephone Number (if available)
Employment Dates: Begin/End
Your Position/Nature of Work/Responsibilities
3. Employer Name/Company, Address (City/State sufficient) and Telephone Number (if available)
Employment Dates: Begin/End
Your Position/Nature of Work/Responsibilities

References

Please provide the names of four persons who have knowledge of your character, experience, work habits, skills and abilities. These references could be persons you have listed under Previous Camp Experience and/or Employment History above. You might also list a high school teacher, college professor, guidance counselor, clergy person, adult supervisor, etc. (Please do not list relatives, family friends and/or peers such as personal friends, roommates or classmates). Again, be sure to include as much contact information as possible so that we can easily contact them for a reference.

*Name
*Relation to you
Phone #
Email Address

*Name
*Relation to you
Phone #
Email Address

Name
Relation to you
Phone #
Email Address

Name
Relation to you
Phone #
Email Address

Health/Diet

Summer camp is strenuous and demanding: as a camp staff person, you would need to be in good physical and emotional health to keep up with the campers. If you respond YES to any of the questions below, please explain where indicated.

*1. Are there any reasons you may have difficulty in performing any of the essential functions of the position(s) for which you have applied? (For example, caring for the safety and well-being of children, other staff members and yourself?)
Yes    No
*2. Do you have any allergies?
Yes    No
*3. Do you smoke?
Yes    No
*4. Would you be able to refrain from smoking during camp's contractual period - both while working as well as on time-off?
Yes    No
*5. As a camp staff member, you will give up a great deal of privacy and comfort, work hard and long hours, adhere to camp policies which are limiting (time-off restrictions, camp menu, no smoking, no alcohol, etc.) Do you foresee any problem complying with this type of lifestyle?
Yes    No
If you answered "Yes" to any of questions 1-5 please explain fully:

Verification Information

When completing this section do not disclose information regarding juvenile court convictions or minor traffic violations. A conviction record does not automatically bar you from employment with Camp Kamaji. Providing false information, misrepresenting criminal conviction history, or omitting information will lead to disqualification from further consideration of your application for employment, or termination of your employment.

*1. Have you ever been convicted of, pled guilty or no contest to, been imprisoned, or on probation for any felony?
Yes    No
*2. Have you ever been convicted of, pled guilty or no contest to, been imprisoned, or on probation or parole for any misdemeanor?
Yes    No
*3. Do you currently have any criminal charges pending against you?
Yes    No
*4. Are you currently on probation?
Yes    No
If you answered "Yes" to any of questions 1-4 please explain fully:

Final Questions

If I were employed next summer at Camp Kamaji, I could start as early as
and I could end no later than
How did you first hear about Camp Kamaji?
LAST QUESTION – WE PROMISE!! Please tell us a little more about yourself. Include some background information, your strengths and weaknesses, an explanation of your desire to work at a summer camp and what contribution(s) you think you can make at camp.
*By initialing below, I confirm that the information provided above is accurate and complete.
Initials
Date