Staff Application Program Staff

4. Gender: Female Male Trans Other (Please specify below)

4. Gender - Specify

4. Legal Name

4. Social Security Number

4. Reference #1 (Please be sure to list their full name, email address, phone number and relationship to you.)

4. Reference #2 (Please be sure to list their full name, email address, phone number and relationship to you.)

4. Reference #3 (Please be sure to list their full name, email address, phone number and relationship to you.)

4. Address/Location 1

4. Address/Location 2

4. Address/Location 3

4. Dates Employed 1

4. Dates Employed 2

4. Location 1

4. Location 2

4. Phone 1

4. Phone 2

4. Date/Year employed 1

4. Date/Year employed 2

4. Date/Year employed 3

4. Have you ever been a camper?

   1. Yes
   2. No

4. If yes, list camp and dates:

4. CAMP STAFF EXPERIENCE (Unless you request otherwise, previous camp supervisors listed will be contacted as references.) - Name of Camp 1

4. Name of Camp 2

4. WORK/COMMUNITY SERVICE EXPERIENCE - Name of firm/agency/organization 1

4. Name of firm/agency/organization 2

4. Name of firm/agency/organization 3

4. Phone 1

4. Phone 2

4. Phone 3

4. Position 1 (include age of campers)

4. Position 2 (include age of campers)

4. As a bunk counselor, you will be assigned to live with a bunk of campers. Please select the age group you prefer:

   1. 8-10
   2. 11-12
   3. 13-14
   4. 15-16
   5. wherever I am needed

4. Age/Sex of children

4. Is there anything else you would like to tell us about yourself? Do you have any questions?

4. Are you available for an interview in New York?

   1. Yes
   2. No

4. Camp position for which you are applying

4. Describe your three best activities. Tell why you like them, and why you might enjoy teaching them to children. Please be as specific as possible, noting if you have particular teaching experience and/or if you are especially skilled at something you would like to try to teach.

4. What do you regard as the duties, responsibilities and important aspects of the position you are applying for? (counselor, group leader, specialist, etc.)

4. Grade or year you are now in

4. If not, what is your citizenship?

4. I have the following certifications:

   1. WSI
   2. Lifesaving
   3. CPR
   4. First Aid
   5. Driver's License
   6. Other (list below)

4. Interest/Major Studies

4. When?

4. List diplomas or degrees you have received to date

4. Married/Domestic Partner?

   1. Yes
   2. No

4. Name of school you are now attending

4. Other Special Training/Certifications

4. How would you describe your philosophy of working with children? What are the things you believe are most important?

4. Please state your approximate salary requirements

4. What are your previous experiences with community living? What do you regard as the challenges and benefits of living, working, and sharing closely with people for a summer?

4. Until what date can we contact you at this address?

4. U.S. Citizen?

   1. Yes
   2. No

4. What most concerns you about a summer at Kinderland?

4. What most excites you about the possibility of a summer at Kinderland?

4. Why do you want to work at Camp Kinderland in particular?

4. Will family accompany you to camp?

   1. Yes
   2. No

4. Supervisor or Camp Director 1

4. Supervisor or Camp Director 2

4. Your Position 1

4. Your Position 3