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Personal Information
   
First Name * Last Name *
Cell / Current Phone # Home Phone #
School Street Address Home Street Address *
School City Home City *
School State/Province Home State/Province*
School Zip Code Home Zip Code
School Country Home Country
Social Security Number Email Address *
* Required for US Citizens
Date of Birth * Gender
/ /
How Did You Hear About Us?  
High School Graduation Date
High School /
College Major
College
 
Current Year in College  
 
   

Camp Experience - As Either a Camper or Staff Member (Not Required For Placement)
   
Camp: Director:
Phone: Dates:
Salary:
   

Previous Employment
   
Employer's Name: Contact Person:
Phone: Dates of Employment:
Salary:
   
   
Employer's Name: Contact Person:
Phone: Dates of Employment:
Salary:
   

Position You Are Applying For:


Additional Skills Information
   

There may be an occasion where we will ask you to help out in a particular area. Consequently, we would like to know if you have a background in any or all of the areas listed below. Please select all of the areas that apply to you.

Please put 1 before the following activities you can organize and teach as an expert, 2 for those activities you can assist in teaching, and 3 for those in which you have had some useful experience.
1 = ability to organize & teach
2 = ability to assist in teaching
3 = some possess some useful experience

1 2 3 Sports
Basketball
Softball
Soccer
Tennis
Golf
Roller Hockey
Lacrosse
Baseball
Volleyball
 
1 2 3 Fitness
Weight Training
Running
Aerobics
Cheerleading
Martial Arts
 
1 2 3 Outdoor Activities
Ropes Course
Hiking
Mountain Biking
Overnights
Horseback Riding English
Science & Nature
 
1 2 3 Watersports
Swimming
Diving
Lifesaving
Water Aerobics
Sailing
Windsurfing
Canoeing
Water-skiing
Motorboat Driving
 
1 2 3 Gymnastics
Beam
Bars
Floor
Vault
Coaching
1 2 3 (Performing) Arts
Theater
Dance
Piano
Guitar
 
1 2 3 Miscellaneous
Archery
Radio/DJ
Fishing
Go Carts
 
1 2 3 Crafts & Electives
Woodshop
Ceramics
Stained Glass
Macrame
Fabrics
Model Making
Tie-Dying
Jewelry Making
Painting
Rocketry
Candles
Silk-Screen
T-Shirt Design
Masks
Electronics/Robotics
Cooking
 
1 2 3 Support Services
Maintenance
Grounds
Carpentry
Plumbing
Laundry
Housekeeping
Chef/Cooking
Salads/Pantry
Waiter/Waitress
Web Design Skills
Digital Photography
 
Please let us know if you can teach or have talents in other areas (i.e. magic, juggling, etc.):
If you are applying for a specialty position, please indicate any training, teaching, coaching or other experience you have had in the specialty area.
 
Do you currently hold any of the following Certificates or Licenses? If so, please list expiration dates:
WSI First Aid
Suffolk Lifeguard Cert. CPR/Type
BLS Comm. Drivers License (CDL)
 

Age Group Preference & Availability
     
Please indicate first and second choice.
1st choice of age group of campers you prefer:
3-5 6-8 9-10 11-15 Flexible
2nd choice of age group of campers you prefer:
3-5 6-8 9-10 11-15 Flexible
 
Please indicate the dates you are available for camp:
June - August , 2009
You must be available from mid June until August 22, 2009
 

Please spend some time considering the following questions which will help us determine your ability to work at the position you have applied for.
 
What are your 3 best qualities?
 
If you were the director of a day camp, what would its philosophy be?
 
What are the most important things for a counselor to teach a young child?
 
If you could change anything in your life, what would it be?
 
Who are your two heroes/heroines?
Describe an unforgettable experience that you have had with a child.
Who referred you to work at Hampton Country Day Camp?
 
Have you ever been convicted of a felony or misdemeanor? Have you ever been involved in an incident involving sexual or physical abuse to a child?
 
If you answered yes to either of the above questions, please explain the circumstances.
 
Do you have any physical condition or disease that would affect your ability to perform? If yes, please explain:
 
Staff members 21 years of age and older are generally required to drive a mini bus for us in addition to their in camp duties.
Are you 21 or older and willing to drive a mini bus?
 
Staff members under 21 may be needed as bus counselors.
Are you under 21 and willing to be a bus counselor?
 
PLEASE BE AWARE THAT WE CONDUCT BACKGROUND CHECKS ON ALL EMPLOYEES
 
Do you smoke? Yes No
 


Please review the above application before clicking the Submit button. Submitting this form will serve as your acknowledgment that the above information is correct.

I agree to allow Hampton Country Day Camp to do a background check and I affirm that all the above information is true to the best of my knowledge.*


 

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