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CAMP EVELYN
2012 Staff Application

 
Full Name Are you: Male Female
Email Address By June 10, 2010 you will be at least: 16 18 21
Home Address
City State Zip
Permanent Phone Cell Phone
College Address
City State Zip
Earliest date you are available Latest date through which you can remain
Where did you learn about this job opportunity

POSITION(S) APPLYING FOR

After reviewing the job descriptions and qualifications found in the summer opportunities information on the council website, www.gsmanitou.org, please check all those for whcih you would like to be considered.

Assistant Camp Director Unit Coordinator Head Cook
Activity Coordinator Counselor Assistant Cook
Health Supervisor Lifeguard Kitchen Aide
Waterfront Coordinator Retail Coordinator Counselor-in-Training Coordinator

 EDUCATIONAL BACKGROUND
High School Name
College Name:
Location
Year Graduated
Location
Year Graduated
Major Subjects or Electives
Major Course Work and Activities

EMPLOYMENT HISTORY
Employer/Company
City/State
Position
Responsibilities
Dates Employed
     
Employer/Company
City/State
Position
Responsibilities
Dates Employed
   
Employer/Company
City/State
Position
Responsibilities
Dates Employed
     
Employer/Company
City/State
Position
Responsibilities
Dates Employed


CAMP EXPERIENCE  (as a campter or staff member)
Camp Name City/State
Type of Camp, Work Experience, Length of Time

LICENSES, CERTIFICATIONS AND TRAINING

Please list all current certifications (Lifeguard, Lifeguard Instructor, Water Safety Instructor, First Aid, CPR, First Aid and CPR Instructor, AED, R.N., L.P.N., E.M.T., First Responder, SafeServe, Archery Instructor, etc.)

Certifications: Expiration Date:

REFERENCES

We recommend former employers, teachers, clergy, counselors, youth program leaders or other persons who can give an honest account for your qualifications to work at Camp Evelyn. References by personal friends or relatives will not be considered. Please list three individuals.

Name Relationship Phone Number Years Known


PLEASE RESPOND TO THESE QUESTIONS THOROUGHLY:
Describe yourself using at least five different adjectives:

Please give some examples of experiences that you have had working with children in which you feel you have made a lasting impact.

Why do you want to work at Camp Evelyn this summer?

Which age group would you prefer working with (1 being the most, 4 being the least)
Ages 9-11 Ages 11-14 Ages 14-17


SPECIFIC SKILLS

Read the following rating system carefully and place the appropriate number in the box after each activity.
1-I have enough experience and confidence to lead this activity.
2-I have experience in this activity and I might be able to lead this activity.
3-I do not have much experience but I could assist someone with leading this activity.
4-I have absolutely no experience or familiarity in this activity but would be willing to assist someone and learn as I go.
5-I would not want to participate in this activity.

WATERFRONT SPORTS AND GAMES OUTDOOR SKILLS
CANOEING ARCHERY ORIENTEERING/GPS
KAYAKING BADMINTON SHELTER BUILDING
ROW BOATING BASKETBALL FIRE BUILDING
SWIMMING VOLLEYBALL TRAIL HIKING
WATER AEROBICS SOCCER OUTDOOR COOKING
POOL GAMES ACTIVE GAMES OUTDOOR SURVIVAL
ARTS AND CRAFTS CIRCLE GAMES PRIMITIVE CAMPING
SKETCHING ICE BREAKERS SPELUNKING
PAINTING/WATERCOLOR YOGA HORSEBACK RIDING
LEATHER WORK ZUMBA ENGLISH
POTTERY/CERAMICS PERFORMING ARTS WESTERN
JEWELRY DRAMA/THEATER ARTS DRESSAGE
KNITTING SONG LEADING HORSE CARE
CALLIGRAPHY STORYTELLING NATURE STUDY
PHOTOGRAPHY DANCE: (Please list types below) NATURE EXPLORATION
TIE-DYE ASTRONOMY
CRAFTS: (Please list types below) ENVIRONMENTAL EDUCATION
COMMUNCATION
  MUSICAL INSTRUMENT: (Please list) CREATIVE WRITING
  POETRY
    AMERICAN SIGN LANGUAGE
    FOREIGN LANGUAGE (Please list)
   
Please list any additional skills or activities you can teach that are not listed which you feel would be useful in a camp setting.

Please pick your top three activities that you would most enjoy leading at Camp Evelyn and explain why you chose them.


BACKGROUND CHECK
 
 

If considered for a position with Girl Scouts of Manitou Council, a background check will be completed. Pease provide the following information.

Have you ever been convicted of a misdemeanor, felony or other crime?  Yes No

If yes, please state offense, date and location

Have you ever physically, emotionally, or sexually abused a child?  Yes No

 

If yes, please state offense, date and location

Do you have a driver's license Yes No State of issuance and license #
Have you had your driver's license suspended or revoked in the last four years? Yes
If yes, please explain

INTERVIEW
 
When are you available for an interview? 
 
Best Way & Time to Reach You
Best location for an interview
Girl Scouts of Manitou Office (Sheboygan, WI)
Camp Evelyn (Plymouth, WI)
Other (please specify)

EMPLOYMENT REQUIREMENTS AND WAIVER

I am aware that Camp Evelyn staff members are expected to become first and CPR certified upon hire, training is provided.

I understand that Camp Evelyn staff members are expected to complete a physical examination and have a licensed professional sign a health form stating that you are physically well to perform the essential functions of the position before the first day of training.

I am aware that I must become a member of the Girl Scouts of the U.S.A and pay the membership fee prior to the first day of training.

I hereby attest that the information I have provided in this application is accurate and truthful. I understand that untrue, misleading, or omitted information may result in dismissal, regardless of the time of discovery by Girl Scout of Manitou Council. I authorize Girl Scouts of Manitou Council to investigate my statements herein and to contact any or all former employers or any individuals familiar with me or my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information about me or my employment. I understand that as part of the processing procedure for my employment application, an investigative report regarding my criminal and driver’s license records will be conducted.

I understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for any definite period of time. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without cause and with or without notice. 

Applicants "Signature"

Date

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