First Name		Last Name
SS#		E-mail
Street Address		Address Line 2
City			State/Province
Zip/Postal Code			Country
Home Phone			Cell Phone

        Today's Date  (mm/dd/yy)

        Are you between the ages of 18 - 65?    Yes    No     If not state your age: 

        Marital Status:                                             Children:   

    In the following list check off those activities that you can organize and

teach or those activities in which you have useful experience and can assist with:

Swimming            Life Guarding       WSI                 Canoeing
Kayaking            Nature Study        Arts & Crafts       Fishing
Campfire Cooking    Fire Building       Archery             Camping
Overnight Tripping  Challenge Course    Songs & Skits       Games

        What type of position are you looking for?                 What age group do you prefer working with?

        Day Camp Counselor Resident Camp Counselor Program Counselor Other                                            Ages 5 - 7 Ages 8 - 9 Ages 10 - 11 Ages 12 - 13        

EDUCATION  

Please list any degrees you may have and indicate where they are from:

 

1.         2.

3.         4.

         PAST EMPLOYMENT 

        Beginning with your most recent employer please list your previous employers:

          Dates                         Employer                          Address                            Position

         CAMP EXPERIENCE (Please indicate camper or staff):

         Describe any First Aid courses you have completed and certifications you have received:

REFERENCES  Please provide us with the names, phone numbers, and addresses of 3 people

who have knowledge of your skill level, personality, and work ethic, and who will be willing to send

us a letter of reference to the above address:

Name                                           Address                                              Phone # 

            

            

            

                                   What contributions do you think you can make at Camp Talooli?

                        What contributions do you think a well run camp can make to children?

                            Do you have any impairments, physical or mental, which would interfere

                        with your ability to perform the job for which you have applied? If so, explain:

        Give us a brief biographical sketch, including specialized training in camping, and experience

    and/or training in other fields which might have a bearing on the position(s) for which you are applying:

Have you ever been convicted of a felony or child-related crime/abuse allegation?         Yes     No        

If yes please explain: 

I HEREBY STATE THAT THE INFORMATION PROVIDED ON THIS FORM IS TRUTHFUL AND ACCURATE

AND WILL BE CONSIDERED A PART OF ANY CONTRACT I ENTER INTO FOR EMPLOYMENT AT CAMP TALOOLI.

Applicant Signature (enter your name)