Staff Application

Last Name  

First Name  

S.S. #    

E-mail  
Permanent Address          
Street      

 Phone
Town   Zip

Cell
           
School Address          
Street          
Town   Zip

Phone
           

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
Job1      
Job2      
Job3      
 
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
 
HAVE YOU EVER BEEN ACCUSED OR CONVICTED OF ANY OF THE FOLLOWING:
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?  

2012 season is Monday June 25 - Friday August 10
4 day mandatory training June 14-17, and evening of July 18th.
Do you have any conflicts with the above dates?
YES NO   
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: