Camp Mack New Staff Fill In Application
User Manual: Camp-Mack-New-Staff-Fill-In-Application
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Return Completed App. to: Ben Wohlberg Camp Director (DVW2UDQJH6W $SW Lititz, PA 17543 Ben.Wohlberg@gmail.com Personal Information Full Name: __________________________________________________________________________________ Street Address: _______________________________________________________________________________ City: ______________________________________ State: _______________ Zip Code: ____________________ Phone Number: (_____)____________________ Cell Phone Number: (_____)_________________________ E-Mail Address: _____________________________ Social Security Number: _______-______-______________ Driver's License # _____________________ State:_________ Parent / Guardian :___________________________ Relationship:_____________________________________ Street Address:_______________________________________________________________________________ City: _______________________________________ State: _________ Zip Code: _________________________ Phone Number: (_____)______________________ Work Number: (_____)_______________________________ Alternate Number: (_____)____________________ Emergency Contact :_________________________ Relationship:______________________________________ Street Address: _______________________________________________________________________________ City: _______________________________________ State: _________ Zip Code: _________________________ Phone Number: (_____)______________________ Work Number: (_____)_______________________________ Alternate Number: (_____)____________________ Employment History (Begin with most recent or current employer.) 1. Employer:___________________________________ Position: ______________________________________ Supervisor Name: _____________________________ Phone Number: __________________________________ Dates of Employment: ________________________ Reason For Leaving:________________________________ 2. Employer:___________________________________ Position: ______________________________________ Supervisor Name: _____________________________ Phone Number: __________________________________ Dates of Employment: ________________________ Reason For Leaving:________________________________ Personal References (List people unrelated to you who have personal knowledge of your abilities) 1. Name: _____________________________________Home Phone: (____)______________________________ Address:__________________________________________ Work Phone: (____)__________________________ Relationship: __________________________________________ How Long Known ? _____________________ 2. Name: _____________________________________Home Phone: (____)______________________________ Address:__________________________________________ Work Phone: (____)__________________________ Relationship: __________________________________________ How Long Known ? _____________________ Scouting Experience Current Troop/Team/Crew/Post #______ District: _________________ Council:___________________________ Current Rank: ____________ Current Position: ___________________ Renewal Date: _____________________ Please List any Special Awards / Honors Received: __________________________________________________ ____________________________________________________________________________________________ Tenure: (# Years registered) Youth: _______ Adult: _______ Prior Leadership: ___________________________ ____________________________________________________________________________________________ Previous Camp Staff Experience (list position(s), year(s), camp(s)): ____________________________________________________________________________________________ ____________________________________________________________________________________________ Scout Training (courses and year completed- include National Camp School, BSA Lifeguard, JLT, etc.) ____________________________________________________________________________________________ ____________________________________________________________________________________________ Other Training ( courses and year completed- include Red Cross First Aid, CPR, NRA, EMT, etc. ) ____________________________________________________________________________________________ ____________________________________________________________________________________________ Order of the Arrow Member ( ) Yes ( ) No If yes, check one: ____Ordeal ____Brotherhood ____ Vigil Scouting Skills/Knowledge - Place a check mark beside each of your qualifications /skills below: Aquatics � BSA Lifeguard � Canoeing � Lifesaving � Rowing � Snorkeling BSA � Swimming � Kayaking Outdoor Scout Skills � Camping � Cooking � Hiking � Orienteering � Pioneering � Leave No Trace � Fishing � Knot Tying � GPS Orienteering Shooting Sports � Archery � Rifle Shooting Ecology / Conservation � Astronomy � Bird Study � Environmental Science � Mammal Study � Nature Study � Oceanography � Reptile & Amphibian Study � Soil & Water Conservation � Weather Handicraft � Basketry � Indian Lore � Leatherwork � Wood Carving Other � Cycling � First Aid � Citizenship Program (General) � Leading Games � Leading Songs � Prayer / Worship Services � Campfire Programs � Bugling � Musical Talent : _____________________ specify instrument(s) List any other camp-related qualifications you may have: ____________________________________ ____________________________________ Positions Available at Camp Mack: Indicate your preference by numbering your first, second, third choice, etc. for each position in which you are interested. Please note the minimum age requirements. All applicants must be at least 15 years of age for paid positions and a minimum of 14 years of age and at least 1st Class rank for C.I.T. Training. ____ BB Range Instructor (18) Position (Minimum Age) ____ Camp Director (21) ____ Program Director (21) ____ Commissioner (21) ____ TP Manager (18) ____ Trading Post Clerk (15) ____ Health Officer / EMT / Nurse (18) ____ Aquatics Director (21) ____ Asst. Aquatics Director (18) ____ Aquatics Instructor /Guard (15) ____ Shooting Sports Director (21) ____ Archery Range Director (18) Age On ____ Archery Range Instructor (15) June 1 ____ Nature Director (18) ____ Nature Instructor (15) _______ ____ Campcraft Director (18) ____ Campcraft Instructor (15) ____ Handicraft Director (18) ____ Handicraft Instructor (15) ____ Counselor in Training C.I.T. (14) (non-paid position-3 wk. commitment, incl. staff week) Primary Position of Interest:_____________________________ Salary Range Desired: ____________________ When is the best time to call you to arrange an interview ? _____________________________________________ Personal Statement: Please comment briefly on why you want to work at Camp Mack: ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ The Pennsylvania Dutch Council, B.S.A. is an equal opportunity employer. Applicants are considered for positions without regard to race, color, religion, sex, national origin, age, marital or veteran status or the presence of a health problem or handicap condition that is unrelated to the person's ability to perform the job assigned. Applicants are not required to provide any information that is prohibited by federal, state, or local law. The Boy Scouts of America maintains that no member can grow into the best kind of citizen without recognizing his obligation to God and, therefore, acknowledges the religious element in the training of members, but it is absolutely nonsectarian in its attitude toward the religious training. It's policy that the organization or institution with which the member is connected shall give definite attention to his religious life. Only persons willing to agree with this declaration of principal and the Bylaws of the Boy Scouts of America shall be entitled to certificates of leadership. As a precondition of employment, Pennsylvania Dutch Council camp staff applicants must agree to become a registered member of the Boy Scouts of America, have appropriate uniforms for camp, and provide a current medical examination (B.S.A. parts A, B & C ) prior to camp. I hereby make application for summer employment and in the accordance with the principles of the Boy Scouts of America, I promise to subscribe to the Scout Oath, Scout Law, and Declaration of Religious Principle and I agree to the preconditions of employment as set forth above. I agree to be loyal to and cooperate fully with all B.S.A. policies, programs, and management. I understand that a personal interview may be required before employment will be granted. I understand that completing this application does not guarantee employment. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I authorize all previous employers, schools, and all other references to furnish the information requested. I hereby declare that the information provided by me in this application for employment is accurate and complete to the best of my knowledge. I understand that employment is at the will of the Pennsylvania Dutch Council and any falsification or misrepresentation in this application is cause for discharge. Applicant's Signature: ________________________________________________ Date: ___________________ Parent / Guardian Signature (if under 18): _______________________________ Date: ____________________ Scoutmaster Recommendation: I recommend this Scout, a member in good standing in my troop, for employment on summer camp staff : ____ Yes _____ No Comments___________________________________________ ____________________________________________________________________________________________ Scoutmaster's Signature:______________________________________________ Date: _____________________ FOR OFFICE USE ONLY ~ DO NOT WRITE BELOW THIS LINE References checked (initial / date) _____________ Interview arranged for (date / time) ______________________ Interviewed By: ___________________________________________________ Date: _______________________ Comments:___________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ Approved Time / Days off: ______________________________________________________________________ Position Offered: __________________________ Salary Offered: $______ per week x _____ weeks = $________ Contract package mailed (date) _______________ Contract received in office (date) _______________
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