Staff Information
Online Application

Last Name

First Name
Permanent Address
City 
State Zip 
Phone w/Area Code
Date of Application(mm-dd-yyyy format)
Date of Birth(mm-dd-yyyy format)
Social Security No
E-Mail Address

School/Business Address  

City

State

Zip Phone

Where do we contact you?

Your Age--Please Pick One Group?

Male/Female

Do you have a valid drivers license?

State Licensed in:

If hired we will need a copy of your license.

College Attended

Years Degree

Major

Minor

Extra Curricular Activities

CAMP EXPERIENCE

(List most recent employment first)

Camp Address

Director Position

Dates

***

Camp Address

Director Position

Dates

TEACHING EXPERIENCE

School Address

Phone Position

Dates

***

School Address

Phone Position

Dates

OTHER WORK EXPERIENCE

(Please include contact names and address)

REFERENCES
(P) Personal--(W) Work
INCLUDE at least 1 work reference

Name

Address

Phone

Position

P/W

CURRENT CERTIFICATIONS
First Aid

Exp Date 

CPR Certificate

Exp Date 

Water Safety Instructor

Exp Date 

Lifeguard

Exp Date 

Small Craft Canoeing

Exp Date 

Small Craft Sailing

Exp Date 

Stable Management

Exp Date 

Archery Instructor

Exp Date 

AREAS OF EXPERTISE

Check number "1" in those activities you are best qualified to organize and teach, check number "2" if you can assist in teaching.

ACTIVITY

 1 2

ACTIVITY

 1 2
Swimming Photography
Diving Archery
Racing Basketball
Synchronized Field Hockey
Canoeing Golf
White Water Lacrosse
Kayaking Newcomb
Sailing Soccer
Water Skiing Softball
Wake Boarding Tennis
Drive Motor Boat (Non Teach) Volleyball
Horseback Riding (English) Climbing Wall
Jumping Zip Line
Balance Beam High/Low Elements
Floor Exercises Drama
Tumbling Acting
Uneven Parallel Bars Directing
Aerobics Choreography
Ballet Hiking
Jazz Dance Mountain Climbing
Modern Dance Outdoor Cooking
Tap Dance Overnite Camping
Ceramics Nature
Potter's Wheel Compass Use
Drawing & Painting Computers-List Progs

Silver & Metal Work
Enameling

ADDITIONAL SKILLS-NON TEACHING

ACTIVITY ONE TWO ACTIVITY ONE TWO
Costuming Lighting
Music-Piano Bookkeeping
Sight Reading Dictation
WPM 
Transposing Typing
WPM
Guitar

Other Instruments (List)
Technical
Set Construction

Please describe your experiences, including any teaching you have done, in those activities your marked with a "1". Only include those activities you would feel comfortable teaching to campers. Also indicate any competitive or tournament experiences.

CRIMINAL RECORD

There will be State Police/DA's Office Criminal background checks before employment!
Have you ever been convicted of child abuse or a sex-related crime?

Have you ever been convicted of a felony or misdemeanor?

If yes, give date and details for each conviction

Please include any additional information you feel would be helpful to us in considering you for the position of counselor at Camp Walden

 

Which age group would you prefer to live with?

What experiences have you had with this age group
Salary Requested

Does any portion of this include estimate of transportation expenses?

If so--How much?

Are you employed now?

Where?

Are you authorized to work in the United States

If accepted for employment you MUST provide documentary proof of identity and authorization to work in the United States within 72 hours of hire!