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Please Note: If you press enter while filling out this
form, it will automatically send this form to us. Use tab to move
between fields.
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Full Name: |
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Email: |
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Permanent Address: |
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Dates and Time Expected at this address: |
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Street and Number: |
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City: |
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State: |
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Country: |
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Zip |
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Phone: |
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Cell Phone: |
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School or Winter Address (if
any) |
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Dates and Time Expected at this address: |
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Street and Number |
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City: |
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State: |
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Country: |
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Zip: |
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Phone: |
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Staff Shirt Size:
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Small
Medium
Large
XLarge
XX Large
XXX Large
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Education: |
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School 1 |
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Years Attended: |
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School: |
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Major Subjects: |
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Degree Granted: |
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School 2 |
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Years Attended: |
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School |
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Major Subjects: |
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Degree Granted: |
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Past Employment (List last 3 Employers) |
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Employer: |
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Employer Address: |
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Dates Employed: |
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Employer Phone: |
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Direct Supervisor: |
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Nature of Work: |
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Reason For Leaving: |
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Employer: |
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Dates Employed: |
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Employer Address: |
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Employer Phone: |
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Direct Supervisor |
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Nature of Work: |
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Reason for Leaving: |
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Employer: |
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Employer Address: |
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Dates Employed: |
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Employer Phone: |
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Direct Supervisor: |
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Nature of Work: |
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Reason for Leaving: |
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Indicate any employer you would not like us to contact at this time.
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Camp Experience: |
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Camp Name: |
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Camp Address: |
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Dates: |
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Director: |
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Camper or Staff: |
Camper
Staff |
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Camp Name: |
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Camp Address: |
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Dates: |
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Director: |
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Camper or Staff: |
Camper
Staff |
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References. Please provide names and contact information
for 3 persons (not relatives) having knowledge of your character,
experience and ability. Give each of these individuals a reference form
available on this site |
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Name: |
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Address: |
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Phone: |
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Type of Reference: |
Professional
Personal |
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Name: |
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Address: |
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Phone: |
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Type of Reference: |
Professional
Personal |
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Name |
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Address |
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Phone: |
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Type of Reference: |
Professional
Personal |
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Drivers License: |
Yes
No |
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License State: |
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Difficulty with Duties: |
Yes
No |
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If Yes: |
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Position Desired |
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First Choice |
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Second Choice |
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Age Group Most Desired to Work With: |
Junior
Teen
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Desired Salary: |
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Considering the camp program and positions applying for,
what is your experience in the following |
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Recreational/ Outdoor Skills |
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Softball: |
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Soccer: |
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Archery: |
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Hiking: |
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Field Games: |
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Volleyball: |
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Outdoor Living Skills: |
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Low Ropes: |
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High Ropes: |
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Other: |
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Nature/ Agriculture |
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Barnyard Animal: |
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Pond Studies: |
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Environmental Education |
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Gardening: |
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Other: |
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Creative Arts: |
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Painting: |
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Nature Crafts: |
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Song Leading: |
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Story telling: |
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Play Directing: |
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Instruments: |
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Please List Instruments Played |
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Other: |
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Waterfront: |
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Life guarding: |
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Swim Instruction: |
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Kayaking: |
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Canoeing: |
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Water Games: |
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Other: |
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Other Activities: |
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Evening Programs: |
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Campfire Program: |
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Please List Certifications and Special Training (First Aid, CPR, Lifeguard
Training, Archery, Ropes Course etc) listing dates received and expired: |
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What contributions do you think you can make at camp? |
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What contributions do you think a well-run camp can make to children? |
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Have you ever been convicted of a crime ? |
Yes
No |
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If yes, please explain. Be very specific if the instance involved a
child.: |
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Write a brief biographical sketch including specialized training, or
experience working with youth or other fields that might have bearing on the
position for which you are applying. |
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I Agree |
Important: By clicking this checkbox
signifies my agreement that to the best of my knowledge, the above
information is factual and accurate. Further, I release Camp Howe to
reference this information for it's accuracy. |
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In
accordance with Massachusetts law, summer camps are required to
obtain a criminal background report on all staff working with
children. Part of the application process will require you to
authorize 4-H Camp Howe to receive this information about you.
I authorize investigation of all statements herein and release the
camp and all others from liability in connection with same. I
understand that untrue, misleading, or omitted information herein
may result in dismissal, regardless of the time of discovery by
the camp.
I also permit Camp Howe
to use any images of me taken during the summer for publicity
purposes. Further, I give permission for any photos I take
during camp to be used by Camp Howe or external organizations if
they are in the benefit and promotion of Camp Howe.
Note:
All statements become part of any employee personnel files. |
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