Park Shore Day Camp - country day camp and school

Thank you for your interest in employment at Park Shore Country Day Camp. Please fill out the following information. An application will be sent out to you as soon as possible. We will contact you to set up an interview as soon as we receive your completed application. We look forward to meeting you and sharing all the excitement Park Shore Country Day Camp has to offer.

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Application for Position as Camp Employee

Name:
Social Security #:
Home Address:
Home City:
Home State:
Home Zip Code:
Home Phone:
College Name/Address:
College Phone:
Cell Phone:
* Email Address:
Birthdate:
Age:
Marital Status:

Educational Background

High School:	Grad. Date:
College:	Grad. Date:	Major(s):
College:	Grad. Date:	Major(s):
Grad./Prof. School:	Grad. Date:	Major(s):
What Is Your Present School Year? Freshman Sophomore Junior Senior

Employment History

Name of Business:
Dates:
City/State:
Supervisor:
Salary:
Telephone #:
Positions:
Reason For Leaving:

Name of Business:
Dates:
City/State:
Supervisor:
Salary:
Telephone #:
Positions:
Reason For Leaving:

Name of Business:
Dates:
City/State:
Supervisor:
Salary:
Telephone #:
Positions:
Reason For Leaving:

Experience with Children

Please list all experience with children in school, clubs, etc.

Camp Experience

Please list all camp experience as both an employee and/or a camper.

Name of Camp:
Position:
Years Working:
Salary:
Supervisor:

Name of Camp:
Position:
Years Working:
Salary:
Supervisor:

Name of Camp:
Position:
Years Working:
Salary:
Supervisor:

Extra Curricular Activities

Please list the extra-curricular activities (sports, theatre, etc) in which you are or have been involved with. Kindly include hobbies and/or community service.

High School:

College:

Credentials/Certificates

First Aid:

Standard First Aid:	Yes No
First Aid For Coaches:	Yes No
Responding To Emergencies:	Yes No
Water Safety Instructor:	Yes No
Nassau County Lifeguard Certification:	Yes No
American Red Cross Lifeguard Training:	Yes No

CPR:

Community CPR:	Yes No
CPR For The Professional Rescuer:	Yes No
Training In The Use Of A Defibrillator:	Yes No
Commercial Driver's License	Yes No

If you have any of these certifications, please list the expiration dates:

What Would You Like To Do At Camp?

If you are hired to work in a group, what is your preference? (Please place the #s 1, 2, and 3 in the box indicating your preference.) We will try our best to follow the order you select, however, please understand there is no guarantee.

Pre-School (3 to 5 years old):
Junior (6 to 7 years old)
Senior (8 to 10 years old)
If you have any children that are of camp age, please indicate their names, genders, and ages:
If you were referred to Park Shore by someone please list his/her name and your relationship:
Any obligations requiring time away from camp?

References

Please do not use family members or friends as references. We would like objective recommendations from all references. Please include name, address, phone number, and relationship.

Reference Name:
Address:
Phone Number:
Relationship:

Reference Name:
Address:
Phone Number:
Relationship :

Reference Name:
Address:
Phone Number:
Relationship:

Have you ever been arrested, indicted, or convicted
for any of the following: please answer all.

Child Abuse: Yes No
Sexual Abuse: Yes No
Drug Possession: Yes No
DWI: Yes No
DUI: Yes No

If yes to any of the above, please be specific as to the dates and reasons

NOTE: ALL EMPLOYEES UNDER 18 YEARS OF AGE WILL ALSO BE REQUIRED TO SUBMIT VALID WORKING PAPERS. (NOTE: THIS IS A NYS LAW)
ALL EMPLOYEES UNDER 21 YEARS OF AGE MUST HAVE A BIRTH CERTIFICATE ON FILE IN OUR OFFICE. (OUR OFFICE WILL MAKE A COPY)

By clicking on the submit button you are in essence providing your signature and certify that all the information provided on this application is true and free of falsehood as well as giving the permission to conduct a background check

* I Agree To The Terms Above: