Camp Jorn YMCA


Seasonal Camp Staff Application

* ALL Required Fields must be completed for acceptance. The system will not allow required fields to be left unanswered. Please review entire form and be sure you have ALL necessary information available before you begin.

Position Desired:
(Can list more than one, please list in order of preference)

Dates Available:
From To

* How did you hear about this position?



Personal Information

* Last Name:
* First Name:
Present Address:
City:
State:
Zip:
* Phone Number:
* Email Address:
Permanent Address: Check if same as above, OR complete below:
Address:
City:
State:
Zip:
*Are you a U.S. Citizen? Yes
No
* If not, do you have a legal right to stay and work in the U.S.?
Yes
No



Education
Name & Location of Post
High School Education / School
Diploma, Degree, Certificate or
courses relevant to position
Dates
Name & Location of High School Diploma, Degree, Certificate or
courses relevant to position
Dates


Employment History (Paid or Volunteer)
Please list most recent experience first.

Employer's Name: Position:
Dates Employed:From: To: Employer's Address & Phone Number:
Reason for Leaving: Supervisor's name:
Major Responsibilities: May we contact this employer? Yes
No

Employer's Name: Position:
Dates Employed:From: To: Employer's Address & Phone Number:
Reason for Leaving: Supervisor's name:
Major Responsibilities: May we contact this employer? Yes
No

Employer's Name: Position:
Dates Employed:From: To: Employer's Address & Phone Number:
Reason for Leaving: Supervisor's name:
Major Responsibilities: May we contact this employer? Yes
No


Current Certifications
Please check the box of any current certification you have and indicate the issuing authority and expiration date.

Certification Title

Issuer & Expiration Date

First Aid
CPR
Lifeguard
WSI
Archery
Wilderness First Aid


Other:

Skills Assessment
Each staff member at Camp Jorn YMCA must be proficient and passionate in at least 2 of the following areas with a strong desire to learn more before or throughout the summer.

Please rate yourself 1 - 3 on each activity:

1 = Proficient and Passionate
2 = Definitely willing and able to learn
3 = Not my strongest skill, but willing to learn


Low Ropes Course / Team Building
General Arts & Crafts
Outdoor Cooking
Leave No Trace
Canoe Tripping
Theater Arts
Dance (list types):
Voice / Instruments (list types):
Archery
Basketball
Bicycling
Football
Soccer
Volleyball
Canoeing
Kayaking
Sailing
Waterskiing
Swimming Lessons
Fishing
Gardening
Healthy Cooking
Nutrition
Fitness(list types):


Additional Information

1. Please share an experience where you were able to promote and support the potential of youth.


2. What qualities do you feel you possess that make you a positive youth development professional?


3. What contributions will you bring to Camp Jorn YMCA and how will your presence on our staff team positively impact the youth we serve?


4. What interests you about the position(s) you applied for and how do you see your skill set contributing to those positions as well as camp in general?



References
Please list three references that are NOT related to you who can judge your qualifications for this position. If you have previous experience as a camp staff member at least one reference should be from a camp director or administrator. Please provide complete names, emails, and phone numbers.

By checking off "send", you agree to automatically send the reference listed an email containing a link to our online seasonal camp staff reference check form to complete. The email will simply state your name and that you've applied for a staff position, as well as a link to complete a reference check form. You can view the reference check form by clicking here. While it is not required, you will expedite the hiring process.

Name Phone Number Position Held Email Send

Agreement

By "signing and dating" (by typing your name and date below), I understand that a successful completion of a physical exam and criminal background check are conditions of employment. I certify that all information included on this application is true and complete. I understand that falsification or significant omission of any information may be considered justification for dismissal if discovered at a later date.

* Signature:
* Date