Girl Scouts of Minnesota and Wisconsin River Valleys

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.

Camp Desired:
Please rate camp choices 1,2,3,etc.
with 1 being your first choice

Elk River
Greenwood
Lakamaga
Northwoods
Sanderson
Singing Hills
Whispering Hills
Rolling Ridges
Rochester Area Traveling Day Camps

* How did you hear about this position?
Girl Scout Mailing
Job Fair (which one?):
Internet (please list Web site):
College Career Office (which one?):
Newspaper (which one?):
Other:
Position Desired:
(Can list more than one, please list in order of preference)


Desired Salary:


Dates Available:
From To


* Have you worked at one of our camps in the past?
No
Yes

If yes, which one and when?


Personal Information

* Last Name:
* First Name:
* Middle Initial:
Present Address:
City:
State:
Zip:
* Phone Number:
* Best Time(s) to Contact?
* Email Address:
Permanent 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

Please list Girl Scout experience, if any, and indicate years of participation


Education
Name & Location of School
(High School, College, Grad 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
CPR-PR
Lifeguard
WSI
Archery
Low Ropes
High Ropes
Small Craft Safety
Horsemanship (CHA,HAS)
ServSafe
Drivers License Number:
State:


Please list any other relevant trainings, certifications, workshops, or conferences that you have attended. Include locations, dates, issuing authority and expiration.

Skills Assessment
(Please rate your skill development.)

1 = Never done this, might try
2 = Never done this, but willing to learn!
3 = You bet, I'd like to learn more about this and help teach
4 = Yep, I have done this once or twice
5 = Wow, do I like this! I have done it many times and am ready to learn to teach it to others
6 = Hey, I have taught this and would feel comfortable teaching girls or staff
7 = I would consider myself an expert in this area

Adventure/Challenge
Low Ropes Course
High Ropes Course
Climbing Wall

Arts/Crafts
Ceramics/Pottery/Kiln
Drawing
Painting
Leather Craft
Photography
Nature Crafts
Scrapbooking

Campcraft/Outdoor Skills
Backpacking (list # of days on trail):
GPS/Geocaching
Orienteering
Outdoor Cooking
Leave No Trace
Stove Use (list types):
Wilderness Trips (list # of days):
Knots
Fire Building
Tent Set Up and Care
Canoe Tripping

Dance/Music
Theater Arts
Dance (list types):
Song Leading
Instruments (what kinds):


Nature
Astronomy
Birds
Environmental Studies
Insects
Weather
Ecology
Geology
 Sports/Fitness
Aerobics/Exercise
Archery
Baseball/Softball
Basketball
Bicycling
Horseback Riding (English)
Horseback Riding (Western)
Martial Arts
Soccer
Volleyball
Cheerleading

Waterfront Activities
Board Sailing/ Windsurfing
Canoeing
Kayaking
Water Aerobics
Sailing
Swimming
Swimming Lessons
Synchronized Swimming
Snorkeling
Paddle Boating
Lifeguarding
Fishing
Pontoon Driving

Miscellaneous
Foreign Language (which ones):
Leadership
Storytelling
Team Building
Group Names
Sign Language
Girl Scouts' Own/Ceremonies
All Camp Games
Other Skill 1 (what kind):
Other Skill 2 (what kind):


Additional Information

1. Why are you interested in the position(s) you have listed? What are your qualifications for those positions?

2. What experience do you have working with children?

3. What experience have you had as a camper or camp staff member at any camps? Please list years at each camp and describe experience.

4. Why do you want to work at a Girl Scout summer camp?

5. What special skills will you bring with you and how can you contribute positively towards camp?

6. What contributions do you think a well-run camp can make to children?


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, addresses, emails, and phone numbers. The blank reference forms included with this application packet should also be sent to the references you list below. To expedite the hiring process, you may include completed reference forms in sealed envelopes with this application or have the completed references sent directly to the address above.

Name Business or Home Address,
Email, and Phone Number		 Position Held
1.)
2.)
3.)


* Have you ever been convicted of a crime (other than a traffic violation)?
No
Yes

If yes, please state offense, date and location (a conviction record will not necessarily be cause for disqualification):

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