Full Name
E-mail Address
Current Phone
Social Security Number
Address
City
State
Zip Code
If above address is a school address, list home address also:
(Home) Address
City
State
Zip Code
(Home) Telephone
Program Most Interested In:
PLEASE SELECT ONE
Camp Anne
Harriman Lodge
No Preference
Position(s) Interested In:
Please check any position(s) which interests you.
Program Coordinator
Cabin/Lodge Leader
Cabin/Lodge Counselor
Activity Counselor
Life Guard
Nurse
Cook
Secretary
Driver
Housekeeping
Laundry
Wait Staff
Dishwasher
Night Watch Person
Are you under 18 years of age?
Yes No
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status?
Yes No
Can you travel if a job requires it?
Yes No
Do you possess a valid NY or NJ drivers license?
Yes No
Have you been convicted of a felony or misdemeanor in any jurisdiction?
Conviction will not necessarily disqualify an applicant from employment.
Yes No
If yes, please explain:
Education
Please be as specific as possible and list Name and Address of School(s), Course(s) of Study, Years Completed (or current year), and Diploma/Degree(s):
Employment Experience
Start with your present or last job. Include any job related military service assignments and volunteer activities. You may exclude organizations which indicate race, color, religion, gender, creed, age, martial status, national origin, disabilities, citizenship status, sexual orientation or other protected status.
Employer #1 (Most Recent/Present)
Please list: "Employer, Address, Telephone Number(s), Job Title, Supervisor, Reason for Leaving, Dates Employed, Hourly Rate/Salary, and Work Performed
May we contact your present employer?
Yes No
Employer #2
Please list: "Employer, Address, Telephone Number(s), Job Title, Supervisor, Reason for Leaving, Dates Employed, Hourly Rate/Salary, and Work Performed
Employer #3
Please list: "Employer, Address, Telephone Number(s), Job Title, Supervisor, Reason for Leaving, Dates Employed, Hourly Rate/Salary, and Work Performed
Employer #4
Please list: "Employer, Address, Telephone Number(s), Job Title, Supervisor, Reason for Leaving, Dates Employed, Hourly Rate/Salary, and Work Performed
Describe any job-related training received in the United States military:
Experience
Do you have experience at a Summer Camp/Program?
Yes No
Please explain:
Do you have experience with persons who are mentally retarded?
Yes No
Please explain:
Do you have experience with persons with physical disabilities?
Yes No
Please explain:
Other related Experience?
Yes No
Please explain:
List: Current Professional Certifications, Registration, Licenses
Include: State/Expiration Date if Applicable
(i.e. - Lifeguard, WSI, CPR, FIRST AID, SCIP, RN/LPN, etc.)
Comments:
References
Please include at least two supervisors
Reference #1 Include: Name, Address and Phone Number
Reference #2 Include: Name, Address and Phone Number
Reference #3 Include: Name, Address and Phone Number
How Did You Learn About Us:
PLEASE SELECT ONE
Advertisement
Newspaper
Placement Office
Employment Agency
Walk-in
Friend
Relative
Camp Channel
Petersons
Job Trak
Cool Works
Other
If "Other" or if you have more details, please explain:
I certify that the answers given herein are true and complete to the best of my knowledge. I authorize release of any information regarding my employment to AHRC. I also authorize AHRC to check my background for any criminal record.
This application for employment shall be considered active for a period of time not to exceed 90 days. Any applicant wishing to be considered for employment beyond this time period should also inquire as to whether or not applications are being accepted at that time.
I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization.
In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer.