In accordance with the Children's Online Privacy Protection Act, a person must be 13 years of age or older to complete and submit this form. Please Fill Out & Complete ALL Fields. (NOTE: Use "TAB" Key and/or Pointer to Move Between Fields)

* indicates a required field

Job applying for: *
How did you hear about us?


First Name: * Last Name: *
Social Security #: Gender: Male Female
Birthdate (MM/DD/YY): * Height (ft/in): Weight: lbs.

Current Address
Address: *
City: * State: * Zip: *
Phone: * Date current address expires: *


Permanent Address (if different than current address)
Address:
City: State: Zip:
Phone:

Cell Phone: *

E-mail: *

Are you a US Citizen? Yes No
Will You Be Coming With Family?: Yes No
If yes, who will be coming with you? Spouse Children
# of Children Other

Child's Name:
Present Grade: Birth Date (mm/dd/yyyy):

Child's Name:
Present Grade: Birth Date (mm/dd/yyyy):

Child's Name:
Present Grade: Birth Date (mm/dd/yyyy):

Educational Background
High School: Dates Attended:
College/Univ: Dates Attended:
Major: Degree received:

Graduate School: Dates Attended:
Area of Study: Degree received:


Employment History

Previous Camp Employment (please begin with most recent employment)
Name of Camp Employer:
Position Held: Dates Employed:
Supervisor: Supervisor Phone:

Name of Camp Employer:
Position Held: Dates Employed:
Supervisor: Supervisor Phone:

Name of Camp Employer:
Position Held: Dates Employed:
Supervisor: Supervisor Phone:


Previous Full Time Employment (please begin with most recent employment)
Name of Company:
Position Held: Dates Employed:
Supervisor: Supervisor Phone:

Name of Company:
Position Held: Dates Employed:
Supervisor: Supervisor Phone:

Name of Company:
Position Held: Dates Employed:
Supervisor: Supervisor Phone:

Tell Us About You
Please provide an overview of your past experiences that relate to working at a camp:


Why are you interested in working at camp this summer?


What type of impact have you had on children?


What strengths do you envision using while you're at camp?



Top 3 Jobs Applying For
Job:
Description:

Job:
Description:

Job:
Description:


Skills (Check all that you are qualified to teach or assist in teaching)

Experience level: N/A=No Experience; 1=Familiar With; 2=Some Experience; 3=Excel At

Arts & Crafts

 Music/Theatre Athletics
Woodworking Piano Archery
Leather Guitar Baseball
Metal Singing Basketball
Paper Mache Acting

Floor Hockey
Jewelry Improv Football
Ceramics Recorders Golf
Drawing Directing Group games
Cartooning
Scene Design
Gymnastics
Painting Dance
Lacrosse
Sculpture
Camping Mountain Biking
Model Building Camp Craft Ping Pong
Graphic Arts Campfires Roller Hockey
Photography Cooking Soccer
    Hiking Tennis
    Setting Tents Track/Field
    Nature Volleyball

Water Sports   Miscellaneous

 
Model Trains First Aid
Swimming RC Cars Frog Hunting
Rowing Rocketry Magic
Canoeing Aerobics
Juggling
Kayaking Jogging Go Karts
Windsurfing Body Building Cooking
Lifesaving Newspaper Martial Arts
Fishing Video Rollerblading
    Video Editing Climbing Tower/Ropes


Would you be comfortable and are you interested in leading singing for the entire camp and/or accompanying the camp shows? Yes No

What other instrument(s) do you play? Please feel free to include more than one.



Certification
Are you certified in any one of the following areas? (please check all that apply)
Lifeguard
RTE (Responding to Emergencies)
CPR
WSI
Other. Please list



Special Areas of Interest
Please list your special areas of interest (Ex. member of organization or groups)


Personal Camp Experience
Did you attend camp as a child? Yes No

Camp: Day or Sleepaway: Day Sleepaway
Location: Number of Years:

Camp: Day or Sleepaway: Day Sleepaway
Location: Number of Years:

Camp: Day or Sleepaway: Day Sleepaway
Location: # Years:


Driving
Do you have a current Drivers's License? Yes No
Number of years driving?
Do you have any experience driving a 15-passenger van? Yes No
Are you bringing a car to camp? Yes No


Health
Do you have special dietary needs? Yes No
If yes, what type of needs?


Physical/Health Conditions or Limitations (Ex. asthma) Yes No
If yes, please explain



Background Information
Have you ever been involved in an incident involving physical or sexual abuse of a child?
Yes No *
If yes, please explain:


Have you ever been convicted of a felony or misdemeanor? Yes No
If yes, please explain:



Age Group Preference
Please provide your 1st, 2nd and 3rd choice
First Choice: Second Choice: Third Choice:


Personal References
Name: Known how long:
Relationship: Phone:

Name: Known how long:
Relationship: Phone:

Name: Known how long:
Relationship: Phone:


Are you available for a phone interview? Yes No
When is the best time to reach you?
What is the best number to reach you at?

Are you available for a personal interview ? Yes No
When?

Please Read Carefully
I hereby certify that all of the information supplied by me in this application form is truthful and accurate. I understand that any offer of employment will be based on the information on this form. Any false statements, omissions, or inaccuracies included on this form may be cause for the disqualification from consideration for employment or dismissal from actual employment.

The applicant authorizes Camp Eagle Hill and/or its agents, to conduct an independent background investigation. The applicant further authorizes Camp Eagle Hill and/or its agents, to request or receive any information including criminal records, motor vehicle reports, past employment records, education references, or references from any persons, schools, or previous employers.

By typing the word "Agree" in the box, you understand and accept the terms of the above stated paragraph: *