Full Name:
Address1:
Address2:
City:
State:
Zip Code:
Day Phone:
(xxx-xxx-xxxx)
Evening Phone:
(xxx-xxx-xxxx)
E-mail Address:
If above address is a
school address, list home address also:
(Home) Address1:
(Home) Address2:
City:
State:
Zip Code:
(Home) Telephone:
(xxx-xxx-xxxx)
Program Most Interested In:
Camp Anne
Harriman Lodge
No Preference
Position(s) Interested In:
Please check any position (s) which interests you.
Are you under 18 years of
age?
Yes
No
Are you prevented from
lawfully becoming employed in this country because of Visa or
Immigration Status?
Yes
No
Can you travel if a job
requires it?
Yes
No
Do you possess a valid NY
or NJ drivers license?
Yes
No
Have you been convicted of
a felony or misdemeanor in any jurisdiction?
Conviction will not necessarily disqualify an
applicant from employment.
Yes
No
If Yes,
Please Explain:
Education
Please be
as specific as possible and list Name and Address of School(s),
Course(s) of Study, Years Completed (or current year), and Diploma/Degree(s):
Employment Experience
Start
with your present or last job. Include any job related
military service assignments and volunteer activities. You may
exclude organizations which indicate race, color, religion, gender,
creed, age, marital status, national origin, disabilities,
citizenship status, sexual orientation or other protected status.
Employer #1 (Most
Recent/Present)
Please
list: "Employer, Address, Telephone Number(s), Job Title,
Supervisor, Reason for Leaving, Dates Employed, Hourly Rate/Salary,
and Work Performed
Employer #2
Please
list: "Employer, Address, Telephone Number(s), Job Title,
Supervisor, Reason for Leaving, Dates Employed, Hourly Rate/Salary,
and Work Performed
Employer #3
Please
list: "Employer, Address, Telephone Number(s), Job Title,
Supervisor, Reason for Leaving, Dates Employed, Hourly Rate/Salary,
and Work Performed
Employer #4
Please
list: "Employer, Address, Telephone Number(s), Job Title,
Supervisor, Reason for Leaving, Dates Employed, Hourly Rate/Salary,
and Work Performed
Describe any job-related
training received in the United States military:
Experience
Do you have experience at a
Summer Camp/Program?
Yes
No
Please explain:
Do you have experience with
persons who are mentally retarded?
Yes
No
Please explain:
Do you have experience with
persons with physical disabilities?
Yes
No
Please explain:
Other related Experience?
Yes
No
Please explain:
List: Current
Professional Certifications, Registration, Licenses
Include:
State/Expiration Date if Applicable
(i.e. - Lifeguard, WSI, CPR, First Aid, SCIP, RN/LPN, etc.)
Comments:
References
Please
include at least two supervisors
Reference #1
Include: Name, Address and Phone Number
Reference #2
Include: Name, Address and Phone Number
Reference #3
Include: Name, Address and Phone Number
How Did You Learn About Us:
Please Select One
Advertisement
Newspaper
Placement Office
Employment Agency
Walk-In
Friend
Relative
Camp Channel
Other
If
"Other" or if you have more details, please explain:
Agreement
I certify
that the answers given herein are true and complete to the best of
my knowledge. I authorize release of any information regarding
my employment to AHRC. I also authorize AHRC to check my
background for any criminal record.
This
application for employment shall be considered active for a period
of time not to exceed 90 days. Any applicant wishing to be
considered for employment beyond this time period should also
inquire as to whether or not applications are being accepted at that
time.
I hereby
understand and acknowledge that, unless otherwise defined by
applicable law, any employment relationship with this organization
is of an "at will" nature, which means that the Employee may resign
at any time and the Employer may discharge Employee at any time with
or without cause. It is further understood that this "at will"
employment relationship may not be changed by any written document
or by conduct unless such change is specifically acknowledged in
writing by an authorized executive of this organization.
In the
event of employment, I understand that false or misleading
information given in my application or interview(s) may result in
discharge. I understand, also, that I am required to abide by
all rules and regulations of the employer.
By
clicking on the button directly below titled "I AGREE, Send to Camp
Anne and Harriman Lodge," I fully understand and agree to the entire
AGREEMENT above.