First Name:
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Last Name:
|
| |
| Position Desired |
|
Male Counselors |
Music / Drama Specialist |
|
Female Counselors |
Day Camp Specialist |
|
Nurses (LPN or RN) |
Sports & Games Specialist |
|
Medical Technician |
ROPES / Challenge Course Specialist |
|
Lifeguard / Aquatics Specialist |
Facility Maintenance |
|
Equestrian Specialist |
Food Service |
|
Art Specialist |
Other (Describe) |
| |
| If you checked "Other" please describe |
|
| |
| Available Dates: (Camps are generally from the first
of June to the end of August) |
| from
to
|
 |
Email Address:
|
|
Address:
|
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City:
St:
Zip:
|
|
Home Phone:
|
Cell Phone:
|
| |
| Emergency Contact |
First Name:
|
Last Name:
|
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Address:
|
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City:
St:
Zip:
|
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Home Phone:
|
Cell Phone:
|
| |
| Eligibility Information |
| Birthdate:
(mm-dd-yy) |
|
| If hired, can you provide proof of eligibility to work
in the U.S.?
Yes
No |
| |
| Educational History |
High School
(name and location) Graduation Year
|
College / University
(name and location) Level Completed:
|
| |
| Camping Experience (Not Required for Employment) |
Previous Camp Assigned Through WhizResources
|
|
| Do you want to return to the above camp this year?
Yes
No |
|
Name and Location of Other Camp(s) You’ve Attended/Staffed
|
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Describe Camp Experience
|
| |
| Special Needs Experience (Not Required for Employment) |
|
Lifting & Transferring |
Special Olympics |
|
Feeding |
Childcare |
|
Dressing |
Care of Family Member |
|
Supervision |
Other (Describe) |
|
Nursing Home |
|
|
If you checked "Other" please describe
|
| |
| Credentials and
Certificates (Required only for Certain
Positions) |
Nursing
RN or
LPN |
|
License Number:
State:
|
|
| Date Received
(mm-dd-yy) Expiration Date
(mm-dd-yy) |
| |
|
First Aid Certification |
|
| Date Received
(mm-dd-yy) Expiration Date
(mm-dd-yy) |
| |
|
Water Safety Instructor (WSI) Certification |
|
| Date Received
(mm-dd-yy) Expiration Date
(mm-dd-yy) |
| |
|
Red Cross Lifeguard Certification |
|
| Date Received
(mm-dd-yy) Expiration Date
(mm-dd-yy) |
| |
Drivers License No:
|
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| State:
Date Received
(mm-dd-yy) Expiration Date
(mm-dd-yy) |
| |
Other Training,
Licenses, Certifications with Related Information (Describe)
|
| |
| Occupational History and Skills |
| List your three most recent employment and/or volunteer
experiences. |
Business Name:
|
Contact Name:
|
|
Address:
|
|
Phone Number:
|
Dates Employed:
|
| |
Business Name:
|
Contact Name:
|
|
Address:
|
|
Phone Number:
|
Dates Employed:
|
| |
Business Name:
|
Contact Name:
|
|
Address:
|
|
Phone Number:
|
Dates Employed:
|
| |
Describe any skills or talents you bring that will help
you at the camp.
|
|
Briefly state the main reasons you would like to work
at a special needs camp.
|
|
| The best time to reach me for a telephone interview is
(include Time Zone) and the best phone number to call is
(include Area
Code). |
| |
| I certify that the information I have provided above
is true and complete and understand that, if hired, any misrepresentation
could result in removal from my job. WhizResources will process my
application and, at its discretion, may forward it to a camp for consideration
for a summer camp staff position. If I am hired, the contract for my
services will be directly between me and the camp that employs me.
I agree to hold harmless WhizResources for any and all claims arising
from employment related directly or indirectly to the actions of WhizResources
and this Application. I understand that WhizResources is an independently
owned entity, providing services for special needs camps and that WhizResources
is not owned or operated by or otherwise related to any camps or other
non-profit or for-profit organizations owning or managing the camps.
The camps have agreed to pay WhizResources for its services and I will
not be required to make payment to WhizResources unless I terminate
early my contract with the camp, in which case I will reimburse WhizResources
for the round trip air transportation provided or reserved on my behalf
and paid by WhizResources. |
|
|
I agree
I disagree |
Date:
(mm-dd-yy) |
|
|
|
