2010 Staff Application for Employment

Desired Position Please Select --Summer-- Counselor Mentor Co-Counselor Expedition Staff Support Staff Kitchen Staff Nurse/Doctor Summer Intern --Fall-- Mentor Kitchen Staff Support Staff Summer Intern Other   If Other, please specify:

Are you a past camper or staff member of The Green River Preserve? If yes, when?

What are your dates of availability?

Please submit a digital photo this application (optional).

File (please resize if larger than 1MB):

Last Name:   First Name:

Middle Name:   Preferred Name:

Social Security Number:   Date of Birth (mm/dd/yy):

Gender: Male   Female       Marital Status: Single  Married

Age:     T-Shirt Size: Please Select Small Medium Large X Large XX Large       Polo Shirt Size: Please Select Small Medium Large X Large XX Large

Email:     Cell Phone:

Driver's License Number:   State of Issue:

Auto Insurance Company Name:

Insurance Policy Number:

Current/School Address:

City:   State:   Zip:

Telephone:   Address/Phone Good Until (mm/dd/yy):

Permanent Address:

City:   State:   Zip:

Telephone:

Emergency Contact (Name, relationship and phone number):

1. Have you received any moving violations within the past 3 years?
   

2. Have you ever been convicted of a crime other than a traffic violation?
   

3. Have you ever been convicted of sexual misconduct or sexual abuse?
   

4. Have you ever been addicted to or treated for chemical dependence?
   

5. Do you have any special conditions, problems or limitations that might interfere with your ability to perform the job for which you are applying?

6. If married, will you be attending camp with your spouse?

7. Will your spouse also be interested in working at Green River?

8. Will you have children attending camp with you?

9. Would you be interested in a camper tuition/salary trade?

10. Are you a past camper or staff member of another camp?

A counselor lives in a cabin with a group of children and is their leader.

Does this appeal to you?   Yes   No

High School:   Date of Graduation (mm/dd/yy):

Honors and Extracurricular Activities:

College:   Date of Completion (mm/dd/yy):

Majors:

Degree Granted/Expected:

Honors and Extracurricular Activities:

Graduate School:   Date of Completion (mm/dd/yy):

Majors:

Degree Granted/Expected:

Honors and Extracurricular Activities:

Please list people, excluding relatives, who can make a statement regarding your work experience, character, and ability. Please be complete in lisiting information.

1. Employer:   Address:

   City: State: Zip Code:

   Supervisor: Phone:

   Type of Work:

   Dates:   From:  To:

2. Employer:   Address:

   City: State: Zip Code:

   Supervisor: Phone:

   Type of Work:

   Dates:   From:  To:

3. Employer:   Address:

   City: State: Zip Code:

   Supervisor: Phone:

   Type of Work:

   Dates:   From:  To:

4. Employer:   Address:

   City: State: Zip Code:

   Supervisor: Phone:

   Type of Work:

   Dates:   From:  To:

Please list all certifications, awards, and special training and expereince that will be applicable to your summer employment (bring certification cards to camp):

It is your responsibility to obtain 3 References and have them mailed to us. The required pdf form is available for download now or you may return later to the forms, or employment sections of our website. At least one should be a professional reference - please do not include more than one personal reference (no relatives please). References should be able to make an objective evaluation of your work experience, character, and ability.

Name:

Relationship to you:

Address: City:

State: Zip Code: Phone Number:

Name:

Relationship to you:

Address: City:

State: Zip Code: Phone Number:

Name:

Relationship to you:

Address: City:

State: Zip Code: Phone Number:

Understand that The Green River Preserve has a practice of requesting a background check which could include protective services, criminal record check, motor vehicle check, and/or credit history report on prospective employees prior to contract confirmation.

Please rate your ability to teach or assist these activities:

Other camp relevent areas you can teach:

Please list in order of skill and preference the three activities you are most qualified to lead and/or assist. Describe your teaching experienc, qualifications, and proficiency in connection with these activities.

First Preference:

Second Preference:

Third Preference:

A summer position at The Green River Preserve goes beyond general camp skills. It is a demanding job which uses interpersonal skills and personal resources. Please answer the following questions relating them to the specific position for which you are applying.

How would you describe yourself (background, strengths, weaknesses)?

Why are you interested in working for a camp, specifically The Green River Preserve?

Describe your experience(s) working with children, specifically gifted.

What contribution do you think you can make to insure a cohesive and purposeful program at The Green River Preserve?

As part of the camp staff, you will be giving up a great deal of privacy and comfort, working long and demanding hours, and adhering to camp policies which may be limiting and not necessarily reflect your way of living (curfews, time on, time off, lack of privacy, etc.).

Any untrue, misleading, or omitted information herein may result in dismissal, regardless of the time of discovery by the camp. All statements become part of any future confidential employee personnel files. The Green River Preserve is an equal opportunity employer.

Applicant Agreement: This attests that you have answered all questions honestly and accurately and that you have no problem complying with the type of lifestyle indicated by the camp. It also gives permission for the camp to check references, criminal records, and driving records.

Applicant's Signature: