Staff Application On-Line Please complete the following application or download printable version. The information will be sent to our Camp staff for processing.
Full Legal Name:
Age
Gender Male Female
Address:
City:
State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Permanent Address: (if different from above)
Home Phone:
Work Phone:
Phone during school year:
Please indicate best way to contact you the months of January through May
Best Contact: Home Phone Work Phone School Phone
Email Address:
Position desired at Channel 3 kids Camp Counselor Maintenance Housekeeper Kitchen Program Staff *(Program Staff: Arts and Crafts, Archery, Performing Arts, Nature, Recreation, Radio, Computers, Ropes)
List Previous Camp Experience including names of camps and Phone numbers (if none, please indicate)
Camp starts in the middle of June and goes through to the end of August. Do you have any conflicts with this time frame? If so, please explain
High School - Name, Location, Course of Study, Degree or Diploma
College - Name, Location, Course of Study, Degree or Diploma
Graduate School - Name, Location, Course of Study, Degree or Diploma
Additional Education:
Work Reference - Company Information (list complete addresses, supervisor names and numbers, and reason for leaving)
2nd Work Reference - Company Information (list complete addresses, supervisor names and numbers, and reason for leaving)
Activity ProfilePlease choose one of the options.
Outdoor Living Skills
Hiking: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Outdoor Cooking: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Tent Camping: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Ropes Course: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Other:
Swimming Wellness/Fitness/Aerobics
Life Guard: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
WSI: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Creative Crafts
General Crafts: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Painting/Sketching: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Nature Crafts: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Instrument: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
List Instruments:
Drama (shows and skits) No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Dance: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Photography/Video: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
List Other:
Environmental Education
Birds: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Wildlife: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Gardening: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Weather: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Nature Hikes: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Night Hikes: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Plants and Trees: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Recreation
Team Sports: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Archery: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Team Building Initiatives: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Other Skills
Newspaper/Journalism/Radio Broadcast: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Computer Skills: No experience I have experience as an instructor or a leader in this activity I have participated in or can assist in the activity
Please list and explain experience/training that is relevant to the job for which you are applying (please remember to send in copies of relevant certifications).
Are there any restrictions that would prevent you from performing the essential functions of the job, with or without accommodation?
Restrictions:
Have you ever been convicted of any criminal offenses? If so, explain
Additional Comments:
By submitting this form, you are allowing Channel 3 Kids Camp to verify the information provided.