Camp Killoqua Summer Staff Application

Name:
 E-Mail:
 Are you at least 18 years of age by June 29, 2008? Yes  No
Position(s) Desired: Are you at least 16 years of age by June 29, 2008? Yes  No
Counselor Boating Specialist Bus Driver / Counselor
Unit Coordinator Horseback Riding        Director Nurse
Inclusion Coordinator Horseback Assistant Head Cook
CIT/WIT Director Challenge Course Specialist Assistant Cook
Waterfront Director Craft Specialist Commissary
Waterfront Assistant Tripping Specialist Kitchen Assistant


Present Address:
City: State:   Zip:
Phone:
Until when can we contact you at your present address?

Permanent Address:
City:   State:   Zip:
Phone:

Dates available for employment:  until


School Attending or Present Occupation:
Grade or Level in School:

Education:
       School and/or College            Grade/Year Graduated   Program/Major
1.       
2.      
3.      

Leadership or Camping Experience:


Camp Fire USA or Youth Organization Experience:


Work Experience - Both paid and volunteer other than camping:

Employer Position Dates Supervisor Phone
1.
2.
3.

Camp Experience - Staff or volunteer experiences:

Camp Position Date Camp Director Phone
1.
2.

Experience working with children:


Have you had experience working with developmentally disabled children?
If yes, please explain.


References: Please list three people, other than relatives, with whom you have worked and have known for at least six months. This could be employers, professors, teachers, fellow employees, etc. Please use only one character reference. References will be verified.

Name:   
Position: 		Address:
Phone:   
Name:   
Position: 		Address:
Phone:   
Name:  
Position:		 Address:
Phone:  

Camp Activities - Please indicate your skills in the below areas:

OUTDOOR SKILLS SPORTS AND GAMES
Tools Archery
Fire Building Ropes Course
Backpacking Biking
Camp stoves Large Group Games
Compass Small Group Games
Knots
Outdoor Cooking ARTS AND CRAFTS
Pottery
BOATING Candle Making
Rowing Weaving
Canoeing Batik
Sailing Silk Screen
Windsurfing Kites
Photography
TRIPPING Darkroom
Type of tripping experience:
  MUSIC / DRAMATICS
OTHER Song Leading
Nature Activities Bugle/Trumpet
Horseback Riding Drama
  Folk Dancing
  Guitar

Are there any reasons you may have difficulty in performing any of the essential functions of the job for which you have applied? Yes  No
If yes, please explain:


Do you hold American Red Cross Certificates for:

Waterfront First Aid
Lifeguard Trng Exp. Date
 		Standard Exp. Date
Waterfront Module Exp. Date
 		Advanced Exp.Date
Head Lifeguard Exp. Date
 		Instructor Exp. Date
Course Name:
WSI Exp. Date
 		CPR Exp. Date
Canoeing Instr.
Sailing Instr.

Please list waterfront or first aid certificates other than American Red Cross:


Please list other certificates - horseback riding, archery, outdoor living skills, etc.:


I am interested in working with youth of the following ages: (Please indicate 2 or 3 choices)
 6-8    9   10   11   12-13   14-16        Girls     Boys

Why are you applying for a position at Camp Killoqua?


What will you contribute to the camp community?
(This could include your skills, experiences, etc.)


What do you hope to gain by working at this camp?


Have you had any criminal convictions for child abuse or sex related crimes?
Yes   No

By submitting this application I certify that the information given in this application for employment is true and complete to the best of my knowledge. I authorize Camp Fire USA Snohomish County Council to make inquiry of my former employers or references as to my experience, job suitability, and/or reasons for leaving. I understand that if employed, the making of false statements on this application will be sufficient cause for my dismissal. Employment is contingent upon a satisfactory criminal history check.

Camp Killoqua offers a non-smoking, non-drinking, and drug-free environment for both staff and campers. Employees are expected to support and abide by this philosophy.
    

 

Copyright 2008 - Camp Fire USA, Snohomish County Council