Camp Evelyn Staff Application

Camp Evelyn

2013 Staff Application

Full Name

Are you

Male Female

E-mail Address

By June 9, 2013 you will be at least

16 18 21

Home Address

City

State

Zip

Permanent Phone

Cell Phone

College Address

College City

College State

College Zip

Earliest date you are available

Latest date through which you are available

Where did you learn about this job opportunity

POSITION(S) APPLYING FOR

After reviewing the job descriptions and qualifications found in the summer opportunities information on the council website, www.gsmanitou.org please check all those for which you would like to be considered.

EDUCATION

College Name

Location

Number of Years Completed

Major/Minor & Extra Curricular Activities

High School Name

Location

Number of Years Completed

Key Subjects & Extra Curricular Activities

EMPLOYMENT HISTORY

Employer/Company

City/State

Position

Responsibilities

Dates Employed

Employer/Company

City/State

Position

Responsibilities

Dates Employed

Employer/Company

City/State

Position

Responsibilities

Dates Employed

Employer/Company

City/State

Position

Responsibilities

Dates Employed

CAMP EXPERIENCE (AS A CAMPER OR STAFF MEMBER)

Camp Name

City/State

Camper or Staff Member

Type of Camp and Work/Years Experience

LICENSES, CERTIFICATIONS AND TRAININGS

Please list all current certifications (Lifeguard, Lifeguard Instructor, Water Safety Instructor, First Aid, CPR, First Aid and CPR Instructor, AED, R.N., L.P.N., E.M.T., First Responder, Safe Serve, Archery Instructor, etc.)

Certification

Expiration Date

Certification

Expiration Date

Certification

Expiration Date

Certification

Expiration Date

REFERENCES We recommend former employers, teachers, clergy, counselors, youth program leaders or other persons who can give an honest account for your qualifications to work at Camp Evelyn. References by personal friends or relatives will not be considered. Please list three individuals.

Name

E-mail Address

Relationship

Phone Number

Years Known

Name

E-mail Address

Relationship

Phone Number

Years Known

Name

E-mail Address

Relationship

Phone Number

Years Known

PLEASE RESPOND TO THESE QUESTIONS THOROUGHLY:

Describe yourself using at least five different adjectives

Please give some examples of experiences that you have had working with children in which you feel you have made a lasting impact

Why do you want to work at Camp Evelyn this summer?

What age group would you prefer working with (4 being the most, 1 being the least)

Ages 6-9

Ages 9-11

Ages 11-14

Ages 15-17

SPECIFIC SKILLS

Read the following rating system carefully and place the appropriate number in the box after each activity.

5- I have enough experience and confidence to lead this activity.
4 - I have experience in this activity and I might be able to lead this activity.
3 -I do not have a lot of experience but I could assist someone with leading this activity.
2 – I have absolutely no experience or familiarity in this activity but would be willing to assist someone and learn as I go.
1– I would not want to participate in this activity.

WATERFRONT

Canoeing

Kayaking

Swimming

Water Aerobics

Pool Games

ARTS AND CRAFTS

Drawing

Painting/Watercolor

Leather Stamping

Knitting

Calligraphy

Photography

Tie-Dye

Latch Hooking

Sewing

Jewelry Making/Lanyards

SPORTS AND GAMES

Archery

Basketball

Volleyball

Soccer

Softball

Active Games

Circle Games

Ice Breakers

Teambuilding

Yoga

Zumba

PERFORMING ARTS/COMMUNICATION

Drama/Theater Arts

Song Leading

Storytelling

American Sign Language

Foreign Language (List Below)

List Foreign Language

Dance (List Below)

List Dance

Musical Instrument (List Below)

List Musical Instrument

OUTDOOR SKILLS

Orienteering/GPS

Shelter Building

Fire Building

Trail Hiking

Outdoor Cooking

Fishing

Primitive Camping

Conservation Projects

Environmental Services

NATURE STUDY

Animals

Birds

Mammals

Insects

Plants

Forestry

Wild Flowers

Ecology

Geography

Astronomy

Please list any additional skills or activities you can teach that are not listed which you feel would be useful in a camp setting

Please pick your top three activities that you would most enjoy leading at Camp Evelyn and explain why you chose them

BACKGROUND CHECK

If considered for a position with Girl Scouts of Manitou Council, a background check will be completed. Pease provide the following information.

Have you ever been convicted of a misdemeanor, felony or other crime?

Yes No

(If yes, please state offense, date, and location)

Have you ever physically, emotionally, or sexually abused a child?

Yes No

(If yes, please state offense, date, and location)

Do you hold a valid driver’s license?

Yes No

State of issuance and license #

Have you ever had your driver’s license suspended or revoked in the last four years?

Yes No

(If yes, please explain)

INTERVIEW

When are you available for an interview?

Best way & time to reach you?

Best location for an interview?

Girl Scouts of Manitou Council (Sheboygan, WI)
Camp Evelyn (Plymouth, WI)
Other (Please Specify)

Specify Other

EMPLOYMENT REQUIREMENTS AND WAIVER

I am aware that Camp Evelyn staff members are expected to become First Aid and CPR certified, training is provided.

I understand that Camp Evelyn staff members are expected to complete a physical examination and have a licensed professional sign a health form stating that you are physically well to perform the essential functions of the position before the first day of training.

I am aware that I must become a member of the Girl Scouts of the USA and pay the membership fee prior to the first day of training.

I hereby attest that the information I have provided in this application is accurate and truthful. I understand that untrue, misleading, or omitted information may result in dismissal, regardless of the time of discovery by Girl Scouts of Manitou Council. I authorize Girl Scouts of Manitou Council to investigate my statements herein and to contact any or all former employers or any individuals familiar with me or my employment background for the purpose of verifying any information I have provided and/or for the purpose of obtaining any information about me or my employment. I understand that as part of the processing procedure for my employment application, an investigative report regarding my criminal and driver’s license records will be conducted.

I understand that this application or subsequent employment does not create a contract of employment nor guarantee employment for any definite period of time. If employed, I understand that I have been hired at the will of the employer and my employment may be terminated at any time, with or without cause and with or without notice.

Applicant Signature

Date

For questions, please contact:

Girl Scouts of Manitou Council: Attn: Abby Weber

5212 Windward Court, Sheboygan, WI 53083

920-565-4575 ext: 317

Email: abby@gsmanitou.org www.gsmanitou.org