Personal Information
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| First Name: |
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| Last Name: |
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| Summer Address: |
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| City: |
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| State/Zip: |
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| Day/Eve.Phone: |
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| Cell/Fax Phone: |
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| Email: |
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| Available to work: |
Full Time (8am - 4pm)
AM Part Time (7:30am - 12:30 pm)
PM Part Time (12:30pm - 5:00 pm)
Substitute/On-Call
August Only
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Yes, I am CPR Certified.
Certification Expires on:
(Format: yyyy/mm/dd) |
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Yes, I am First Aid Certified.
Certification Expires on:
(Format: yyyy/mm/dd) |
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| How Did You Hear About Us?: |
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Education |
| High School Name/Graduation Date: |
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| HS City/State: |
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| College Name: |
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| College City/State: |
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| AA Subject/Year: |
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| BA/BS Subject/Year: |
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| MA/MS Subject/Year: |
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Degree Expected:
(Subject/Year) |
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| Other related educational
experiences.... |
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Past Employment History |
| Company 1: |
| Name: |
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| Address: |
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| Phone Number: |
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| May we call as a reference?: |
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| Supervisor Name: |
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| Employment Date: |
Start: End: |
| Job Title: |
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| Responsibilities: |
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| Company 2: |
| Name: |
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| Address: |
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| Phone Number: |
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| May we call as a reference?: |
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| Supervisor Name: |
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| Employment Date: |
Start: End: |
| Job Title: |
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| Responsibilities: |
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Relevant Experiences |
| When did you last work with us?: |
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| What have you been up to since you last worked with us? ( professional, educational, etc): |
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| What is something you will do this summer to improve the Destination Science experience for your campers?: |
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| What was your fondest memory from the last summer you worked with us?: |
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| What was your biggest challenge during your last summer? How did you overcome it? Or if you could do it again what would you do differently?: |
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| Have you ever been convicted of a crime, other than a minor traffic offense? If yes, please provide full details in the box to the right: |
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| I authorize investigation of all statements herein, including any checks of criminal records, and release the company and all others from liability in connection with the same. I understand that if employed, I will be an at-will employee unless there is an agreement of law which alters that status. Furthermore, I understand that any agreement must be in writing and signed by the designated camp official. I also understand that misrepresentations or falsifications herein or in other ducuments completed or submitted by the applicant will result in dismissal, regardless of the date of discovery by the camp. |
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Other Information |
Yes - I am able to attend both days of the Training Workshop:
(select only 1 workshop location) |
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| YES! I am available to work during the following weeks: |
All Sites
6/13 - 6/17 6/20 - 6/24 6/27 - 7/01
7/05 - 7/08* 7/11 - 7/15 7/18 - 7/22
7/25 - 7/29
8/01 - 8/05
8/08 - 8/12
8/15 - 8/19 8/22 - 8/26 8/29 - 9/02
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Preferred Destinations:
(Please refer to the Destinations Listings and
indicate your 1st, 2nd and 3rd preferred destinations.) |
| 1st Preference: |
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| 2nd Preference: |
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| 3rd Preference: |
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