Staff Application

Applying for position of: Select One Fine Arts or Crafts counsellor Music counsellor Drama counsellor Dance counsellor Land Sports counsellor Water sports counsellor Circus / Juggling / Gymnastics Counsellor Maintenance staff Chef or Cook Kitchen Staff * Required

Personal Information:
Last name: * Required
First name: * Required
Middle name:

Social Security Number    Date of Birth    Age next July

Email Address:
Example: you@some.edu
* Required

Permanent Address:
Apartment       
Number/Street   
Town/City       
State/Province  
Zip/Postal code 
Country         

Address at School:
Apartment       
Number/Street   
Town/City       
State/Province  
Zip/Postal code 
Country         

Home phone:  ( )
School phone: ( )

Marital Status: Select one Single Married Separated Divorced
Children (Name, Age, Sex):

Height: Ft / in centimetres
Weight: Pounds Kilogrammes
Do you smoke? Select one no yes

Are you a US citizen? Select one Yes No     Draft Status: Select one Not Applicable Already Served Not yet served

Present Position:
Minimum salary required for full season?  US$

Education Background

High School:

College / University:
  Years
Major Studies:

College / University / Apprenticeships:
  Years
Major Studies:

Camp(s) attended as camper (camp name / summer of)

Previous Employment or Leadership Experiences (List any camps first)

Employer:
Position: Salary: Years:
Address:

Employer:
Position: Salary: Years:
Address:

Employer:
Position: Salary: Years:
Address:

Places you are able to contribute (check ONLY areas you can organize AND teach on your own)

Other - Please give details:

Any extracurricular activities?

Any special condition which will enter into your accepting employment at camp?
Any church or other obligations requiring time away from camp?

I can work at Long Lake up to and including August Select date 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Monday August 29th would be preferred.
Approximate date I need to be back at school:

Have you ever been convicted of a crime, (especially any to do with minors), including traffic violations, or been imprisoned? Select one yes no

Do you have any physical or mental disability that may limit your performance in the job you are applying for? Select one yes no
If YES, what can be done to accommodate you?

References

Please supply two educational, professional or personal references who are familiar with you, can comment on your character and quality of your work, or have worked directly with you,  and have known you for more than a year.

Name:
Relationship:   Phone:

Name:
Relationship:   Phone:

Please tell us how you heard about Long Lake Camp for the Arts: