Staff Application

Last Name  

First Name  

S.S. #    


Permanent Address          


Town   Zip


School Address          
Town   Zip



Educational Background

    Years School Major Subjects Intended Year of Graduation
School 1
School 2

Employment Background

  Dates Employer Address/Phone # Nature of Work Supervisor Reason for Leaving
Please indicate any employer you do not wish us to contact and why:
Camp Experience        
  Dates Camp Director Address/Phone# Camper/Staff
Camp 1
Camp 2
Camp 3
1. Child Abuse:   YES   NO  
2. Sex Crimes   YES   NO  
3. Driving while intoxicated:   YES   NO  
If YES, please explain below:
Do you drive?   YES   NO                  License #:  
Do you have a current Commercial Driver's License (CDL)?
  YES   NO
Would you be interested in getting one and driving a mini school bus? (17 passenger)  
YES   NO  (You must be 21 years old or older)

If you are under 21 years old, you may be used as a bus assistant.  Please check one of the following: 
I would like to be a bus assistant I do not want to be a bus assistant

REFERENCES: Provide names, email addresses, phone # (PLEASE DO NOT USE RELATIVES, FRIENDS, OR FAMILY)
What type of position would you like in camp?  
2015 season is Monday June 29 - Friday August 14
4 day mandatory training June 18-21.
Do you have any conflicts with the above dates?
If yes, please explain

If you have children, are they of camp age? (If yes, please list below):
What age group would you prefer working with? (Please check all that apply)
   4-5    6-7    8-9    10-up    Teen Travel
SWIMMING ABILITY: How would you rate yourself?  
How did you hear about Camp Riverbend?  
In the following lists, select those activities you can organize and teach as an expert.
NOTE: Use the CTRL key for multiple selections.
Arts & Crafts Sports Dance
Music Camp Crafts Drama
Adventure Challenge Nature Miscellaneous
Waterfront Certifications    
If you selected "Other" above, please describe your additional skills below:

What contributions do you feel you can make at camp?

What contribution do you think a well run camp can make to children?
Write a very brief biographical sketch. Include specialized training in camping, or other training that might help you do a good job in a camp setting:
One interesting fact about me is:
I am giving authorization to Camp Riverbend to do a full background search on me, including the performance of sex offender registry and criminal history checks, and release Camp Riverbend and all others in connection with same.  I certify that all the statements and information on this application are accurate and complete.  I understand that any employment offer is based on the accuracy of this application.  If I am hired for a position, I understand that any false statements, omissions or inaccuracies on this application may be cause for dismissal. 
Please Initial: