2021 Staff Application

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'Potential Staff' Information

Email
Must be unique
Title
Potential Staff First name*
Potential Staff Middle name
Potential Staff Last name*
Birthdate
1. Month
2. Day
3. Year
Gender
Primary Phone

Address Line 1*
Address Line 2
City*
Country*
State
State
Zip Code
Picture

Reference #1 (Please be sure to list their full name, phone number, email address and relationship to you.)

Reference #2 (Please be sure to list their full name, phone number, email address and relationship to you.)

Reference #3 (Please be sure to list their full name, phone number, email address and relationship to you.)

Reference #4 (Please be sure to list their full name, phone number, email address and relationship to you.)

Reference #5 (Please be sure to list their full name, phone number, email address and relationship to you.)

Reference #6 (Please be sure to list their full name, phone number, email address and relationship to you.)

Cell Phone

Did you attend a resident summer camp as a child?

Do you give us permission to perform a criminal background check?
1. yes
2. no

Do you have any physical limitations or health problems? If yes, please explain

Do you have any tattoos?
1. yes
2. no

Do you have a valid driver's license?
1. yes
2. no

Do you smoke or chew tobacco?
1. yes
2. no

Have you ever been convicted of a crime?
1. yes
2. no

Have you ever been involved in physical or sexual child abuse?
1. yes
2. no

Have you ever been suspended from any school or university? If yes, please explain

Have you ever received emotional counseling? If so, please explain

Height

List any certifications you hold (First Aid, CPR, etc.)

Please include a few paragraphs on your abilities and/or past experience in working with children

How did you hear about Camp Pinewood?

Weight

What age group do you prefer to work with?

What college or university do you attend?

What is your available end date?
1. Month
2. Day
3. Year

What is your available start date?
1. Month
2. Day
3. Year

What is your major?

What position are you applying for?

What year will you have completed this coming June?

Please include 6 references with this application. 3 references should be based on previous/current employment, and 3 should be character references. Character references are non-related adults that have known you personally for a minimum of 4 years.

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