Staff Application

Please Fill Out & Complete All Fields
Note: Use "TAB" Key and/or Pointer to Move Between Fields


Options of Interest (please check all that apply):

Head Coach Activity Director Office Computer Skills
Staff Coach Travel Co-ordinator/Driver Kitchen Manager/Cook
Coach/Counselor Camp Parents Kitchen Assistance/Food Prep
Counselor Nurse/First-Aid

Cabin Cleaning
Assistant Director Athletic Trainer Snack Shop Assistance


Personal Details


Surname: First Name: Middle Initial:

Correspondence Address (current):

City:

State and/or Country:

Zip or Postal Code:

Phone #: (include Country/City Codes)

Fax #:

Alternate Address:

Please include name of contact person:

City:

State and/or Country:

Zip or Postal Code:

Phone #: (include Country/City Codes)

Fax #:

Social Security Number:

Email Address:



Male Female

Age on June 1, 2008: Date of Birth (MM/DD/YY):

Date of availability:

Arrival:

Date Must depart:

Preferred duration:

Height: Weight:

Year in school: Major:

Education:

College Major Subjects Years Degree Granted

What career do you plan?



Past Employment(List Previous Two Summers or Years):

Dates Employer Address Nature of Work

Camp Experience:

Camper or Staff Camp Director Address Dates

Reference (at least 2): Work Supervisor, Teacher, Volunteer-Work Supervisor,

Team or Activity Manager.

Name
Address, City, Country
Telephone
Position

Background Information:

Do you have a personal religious commitment? Yes No



What is your religion?



Do you attend services? Yes No



Which Church?



What special contributions do you think you can make to Two Rivers?




What does your family consist of? Please list name, relationship, age,
occupation:




What do you believe are the most important personal qualities a
counselor/coach/staff person should have?





Program Information:

Are you currently a student? Yes No

College/University:

Are you employed full-time/part-time? Yes No

Occupation:

Are you a qualified teacher? Yes No

Credential held:

Do you smoke? Yes No

Do you have a current drivers license? Yes No

Are you married? Yes No

Do you have children? Yes No

How many?

Town and country of birth:

Nationality:

If you are from a country other than U.S.A., would you be willing to participate

in the "BUNAC" Registration Program*, if we mutually decide upon a position at

Two Rivers Soccer Camp this summer? Yes No


*The "BUNAC" Program offers such benefits as Flight Arrangements,
J-1 Visa, Medical Insurance, etc.


Medical Information:

Do you have any health problems? Yes No
If yes, please give details:

Do you have any physical disabilities? Yes No
If yes, please give details:

Do you have allergies (asthma; allergies to horses, bees, dust, grass, etc, or require special medical treatment)? Yes No
If yes, please give details:

Do you have any dietary restrictions? Yes No
If yes, please give details:

Do you have medical insurance? Yes No
If yes, please give details:


Coaching Position(s):

Please indicate your main areas of interest current certifications and experience

relevant to this job.

Head Coach/Director of Coaching:

Certificate/Award & Date Obtained:



Center Forward Coach:

Certificate/Award & Date Obtained:



Coach/Couselor Applicants:

Certificate/Award & Date Obtained:





Staff Coach:

Certificate/Award & Date Obtained:





Goalkeeper Coach:

Certificate/Award & Date Obtained:





Please describe your experience relevant to these positions:





Please describe your experience with children:




We reserve the right to conduct a background search on all staff!


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


Counselor Position(s):

Please list below a minimum of three activity areas that you would be comfortable

working with. Keep in mind that you may be placed as a General Counselor. If you

have nursing or athletic therapy training, list your current certification,

registration details.



Activity 1: Please choose one:

Certificate/Award & Date Obtained:



Activity 2: Please choose one:

Certificate/Award & Date Obtained:



Activity 3: Please choose one:

Certificate/Award & Date Obtained:



Activity 4: Please choose one:

Certificate/Award & Date Obtained:



Are you certified in CPR? Yes No



What age level would you prefer in your cabin?

6-8 9-11 12-13 14-16 No preference



Other Skills: (include language)





People with current swimming qualifications, please fill in the following:

Do you hold:
 
Date obtained/Expiration Date
 
Pool Certificate?          YesNo
 
Lifeguard Certificate?     YesNo
 
R.L.S.S. Bronze Medallion? YesNo
 
A.S.A Teacher?             YesNo
 
Preliminary Teacher        YesNo

Other Swimming/Life Guarding Qualifications currently held:

(with date obtained and expiration dates)

Please describe your skills in the areas listed above:



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


Please describe your experience with children:

We reserve the right to conduct a background search on all staff!

Two Rivers has a no tobacco/no alcohol policy on camp property; would this be a problem for you?
Yes No

I have completed this application fully and honestly. I understand that if I am hired for a camp position, I will have to adhere to camp policies such as curfew, no smoking, no drinking and agree to abide by these policies.

By initialing in this box, you are in essence providing your signature.


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