line decor
  
line decor
 
 
 
 

Staff Application


 

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.

Full Name:  
Email:  
Permanent Address:
Dates and Time Expected at this address:
Street and Number:
City:
State:
Country:
Zip
Phone:
Cell Phone:
School or Winter Address (if any) 
Dates and Time Expected at this address:
Street and Number
City:
State:
Country:
Zip:
Phone:
Staff Shirt Size:
Small Medium Large XLarge XX Large XXX Large
 
Education:
School 1
Years Attended:
School:
Major Subjects:
Degree Granted:
School2
Years Attended:
School
Major Subjects:
Degree Granted:
Past Employment (List last 3 Employers)
Employer:
Employer Address:
Dates Employed:
Employer Phone:
Direct Supervisor:
Nature of Work:
Reason For Leaving:
Employer:
Dates Employed:
Employer Address:
Employer Phone:
 Direct Supervisor
Nature of Work:
Reason for Leaving:
Employer:
Employer Address:
Dates Employed:
Employer Phone:
Direct Supervisor:
Nature of Work:
Reason for Leaving:
Indicate any employer you would not like us to contact at this time.  
Camp Experience:
Camp Name:
Camp Address:
Dates:
Director:
Camper or Staff: Camper Staff 
Camp Name:
Camp Address:
Dates:
Director:
Camper or Staff: Camper Staff 
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
Name:
Address:
Phone:
Type of Reference: Professional Personal 
Name:
Address:
Phone:
Type of Reference: Professional Personal 
Name
Address
Phone:
Type of Reference: Professional Personal 
Drivers License: Yes No 
License State:
Difficulty with Duties: Yes No 
If Yes:
Position Desired - First Choice
Position Desired - Second Choice
Age Group Most Desired to Work With: Junior Teen CIT 
Desired Salary:
Considering the camp program and positions applying for, select "3" next to those activities you can organize and teach, "2" for those activities which you can assist in teaching and "1" for those which you have no experience or knowledge.
Recreational/ Outdoor Skills
Softball:
Soccer:
Archery:
Hiking:
Field Games:
Volleyball:
Outdoor Living Skills:
Low Ropes:
High Ropes:
Other:
Nature/ Agriculture
Barnyard Animal:
Pond Studies:
Environmental Education
Gardening:
Other:
Creative Arts:
Painting:
Nature Crafts:
Song Leading:
Story telling:
Play Directing:
Instruments:
Please List Instruments Played
Other:
Waterfront:
Life guarding:
Swim Instruction:
Kayaking:
Canoeing:
Water Games:
Other:
Other Activities:
Evening Programs:
Campfire Program:
Please List Certifications and Special Training (First Aid, CPR, Lifeguard Training, Archery, Ropes Course etc) listing dates received and expired:
What contributions do you think you can make at camp?
What contributions do you think a well-run camp can make to children?
Have you ever been convicted of a crime ?  Yes No 
If yes, please explain. Be very specific if the  instance involved a child.:
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. 
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.
 

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.

Note: All statements become part of any employee personnel files.
 

 
 
 
 
ACA Logo
More Information
for Staff