* required fields    * Name:    Position Applying For:    What is your age?    Date of Birth:    Gender:    Male  Female * Email Address:    * Cell Phone Number:    PERMANENT ADDRESS Street Address:    City:    State:    Zip Code:    Phone:    CURRENT ADDRESS At this Address until:    Street Address:    City:    State:    Zip Code:    Phone:    EDUCATIONAL BACKGROUND College/University Name of Institution Years Attended Year Graduated Degrees Major Minor Graduate Work Name of Institution Years Attended Year Graduated Degrees Major Minor Other Name of Institution Years Attended Year Graduated Degrees Major Minor CAMP EXPERIENCE   Year(s) Name of Camp Position Salary Supervisor Phone# 1. 2. 3. Extra-Curricular Activities: Please describe any extra-curricular activities (ex. youth groups, athletics, school clubs, community service, volunteer work, etc.) and current organization affiliations. Describe any leadership positions held. Work Experience: (list all previous work experience)   Position Employer Address Dates Supervisor 1. 2. 3. CERTIFICATIONS (Please mail photocopies of all current certifications) Driver's License #:   State:   Expiration Date: First Aid, C.P.R. or B.L.S. (Please indicate certifications and expiration dates): Waterfront (Please check and indicate expiration date): A.L.S. W.S.I. Other (specify) SKILLS AND QUALIFICATIONS INVENTORY Considering the camp program and position applying for, Select "1" for those activities which you can organize and teach. Select "2" where you feel you can assist in teaching. Athletics ? 1 2 Basketball ? 1 2 Baseball ? 1 2 Lacrosse ? 1 2 Volleyball ? 1 2 Soccer ? 1 2 Tennis ? 1 2 Golf ? 1 2 Fencing ? 1 2 Martial Arts ? 1 2 Mountain Biking ? 1 2 Gymnastics Waterfront ? 1 2 Canoeing ? 1 2 Boating ? 1 2 Waterskiing ? 1 2 Wakeboarding ? 1 2 Crew ? 1 2 Swimming ? 1 2 Sailing ? 1 2 Tubing Arts & Sciences ? 1 2 Drama ? 1 2 Arts & Crafts ? 1 2 Woodworking ? 1 2 Ceramics ? 1 2 Video Production ? 1 2 Music ? 1 2 Journalism ? 1 2 hotography Extreme Activities ? 1 2 Climbing Wall ? 1 2 Zip Line ? 1 2 Bungee Trampoline ? 1 2 Mini-Bikes ? 1 2 Archery ? 1 2 Go-Karts ? 1 2 Overnight Camping ? 1 2 Trailblazing ? 1 2 Horseback Riding ? 1 2 Campfires Please list any activities or games you can teach that are not listed: Do you have or are you willing to obtain a commercial driver's license? I have a CDL with passenger endorsement. I am willing to obtain a CDL with passenger endorsement How did you find out about Camp Awosting/Camp Chinqueka? REFERENCES Please include references who know of your qualifications and skills, or have supervised you in a professional capacity and can attest to your character. References who can evaluate your work with children, such as former employers, teachers, or school counselors are preferred. Do not use relatives, friends or neighbors as references. Applications are not considered complete if a reference does not include a full mailing address and current telephone number. Two references are required.   Reference Name Address Phone How does reference know you * 1. * 2. 3. Please describe how you would be able to positively affect the lives of our campers: Do you know of any reason why you would not be able to perform the essential functions of the position for which you are applying with or without reasonable accomodation? Yes   No If yes, please explain. Have you ever been convicted of a crime? Yes   No If yes, please mail a separate sheet giving full details. I certify that the above information is true and accurate to the best of my knowledge. I understand that if employed, it will become part of my personnel file and that any misstatement of fact or falsification may be cause for my immediate dismissal. I also acknowledge that Camp Awosting/Chinqueka programs provide a smoke-free environment and that smoking is not permitted on camp grounds. I also understand that application to work at Camp Awosting/Chinqueka indicates my ability to refrain from smoking during my time in camp. I also give Camp Awosting/Chinqueka my permission to run a criminal background check. Signature (type your name) Date: Please type the letters shown in the box below: About Awosting | Programs & Facilities | Campers & Families | Staff | Alumni Contact Us | Register Online | Summer Log In | Home

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