Camp Huntington Staff Application

First Name*:
Last Name*:
Email Address*:
Address*:
City*:
State and/or Country*:
Zip or Postal Code*:
Telephone*:
Additional Contact:
Permanent Address:
City:
State and/or Country:
Zip or Postal Code:
Over 18 yrs of age?* (y/n)
In event of emergency, contact:
Relationship:
Name:
Address:
Phone:
Dates of Availability:
How did you learn about our program?	Online Newspaper Former Staff
Who?
Other:
Are you currently a student?	Yes No
If so, indicate name of school, major and minor areas of concentration, years completed, projected date of graduation and degree expected:
Are you currently employed?	Yes No
Most Recent Employer:
Dates Recently Employed:
Position Held:
Duties:
Supervisor:
Supervisor Address:
Supervisor Phone:
Are there any areas where you feel you are able to teach or have talent in (swimming, art, drama, jewelry making, anything at all-be creative!):
Provide a description of your experience working with children. Include ages, length of time, and any other relevant info:
Provide a description of your experience working with Special Needs. Include ages, length of time, disability, and any other relevant info:
Please list any leadership positions you have held:
Indicate areas in which (A) you have experience and are willing to work and (B) in which you are willing to work but have no prior experience. A B Behavior Management A B CPR A B Dressing A B Feeding A B First Aid A B Hearing-Impaired A B Lifting A B Lifesaving A B Occupational Therapy A B Physical Therapy A B Seizures A B Showering Assistance A B Sign Language A B Speech Therapy A B Toileting A B Visually Impaired A B Wheelchair
What do you think are the most important aspects to being a camp counselor?
Who has had the biggest influence in your life?
What contributions will you make at camp?
Please provide a brief biographical summary:
Have you ever been convicted of any criminal violation of the law, or are you now under pending investigation or charges of violation of criminal law? (Do not respond concerning the following: arrests or detentions that did not result in conviction; referrals to, and participation in, any pretrial or post-trial diversion program; marijuana-related convictions more than two years old; convictions for which the record has been judicially ordered sealed, expunged, or statutorily eradicated; and misdemeanor convictions for which probation has been successfully completed or otherwise discharged and the case has been judicially dismissed.) Yes No
Will you be able to perform, in a reasonable manner, the essential functions of the job for which you are applying? If no is checked, are there any accommodation(s) which would enable you to perform those job functions? Please describe the accommodations. Yes No
I authorize investigation of all statements herein and release the camp and all others from liability in connection with this inquiry. I understand that, if employed, I will be an at-will employee and that any agreement to the contrary must be in writing and signed by the director of the camp. I also understand that untrue, misleading, or omitted information herein may result in dismissal, regardless of the time of discovery by the camp. Please review the above application before clicking the Submit button. Submitting this form will serve as your acknowledgment that the above information is correct. If this page will not go through, please email our Camp Director, Amber Allen, directly at aallen@camphuntington.com.