- Ivy League Day Camp

STAFF EMPLOYMENT APPLICATION

Your Name(Required)

First Last Social Security #

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Birth date(Required)

Age(Required)

Your Email Address(Required)

Position You're Applying For(Required)

PUT A 1 NEXT TO THE AGE OF CHILDREN YOUFEEL MOST COMFORTABLEWORKINGWITH , A 2 NEXT TO THE SECONDMOST AND A 3 NEXT TO THE THIRD.

3-5

Please enter a number from 1 to 3.

6-7

Please enter a number from 1 to 3.

8-10

Please enter a number from 1 to 3.

8-10

Please enter a number from 1 to 3.

13-15

Please enter a number from 1 to 3.

DO YOU HAVE ANY OBLIGATION REQUIRING TIME AWAY FROM CAMP? (Pick One)(Required)

Yes

No

IF YES, EXPLAIN

EDUCATION HISTORY

Name of school - Major - Date Of Graduation

High School

College

IF CURRENTLY IN SCHOOL

GRADE/YEAR

CAMP STAFF EXPERIENCE:

Please list your previous employers, the dates you worked and the position you held

NAME OF CAMP

ADDRESS

DATES

POSITION

EMPLOYMENT EXPERIENCE (OTHER THAN CAMP)

Please list your previous employers, the dates you worked and the position you held

EMPLOYER'S NAME

ADDRESS

PHONE

DATES

EXPERENCE AS A CAMPER

IVY LEAGUE # OF YEARS

Please enter a number from 0 to 20.

EXPERENCE AS A CAMPER

OTHER CAMPS # OF YEARS

Please enter a number from 0 to 20.

INDICATE BY APPROPRIATE NUMBER, THE AREAS BELOW IN WHICH YOU HAVE

1. INTEREST 2. EXPERIENCE 3. TEACHING KNOWLEDGE

MUSIC

DANCE

COOKING

CERAMICS

ROPES COURSE

ATHLETICS

GYMNASTICS

NATURE

SWIMMING

TENNIS

COMPUTERS

ARTS & CRAFTS

WOOD WORKING

ARCHERY

CERTIFICATIONS AND LICENSES

Please entire a date if you have the license listed

ADVANCED LIFESAVING

WATER SAFETY INSTRUCTOR (RED CROSS)

CPR

FIRST AIDER STANDARD

REGISTERED NURSE

LICENSED VAN DRIVER (CDL CLASSIFIED)

OUTSIDE INTERESTS(SPORTS CLUBS, HOBBIES, AWARDS, COLLECTIONS, ETC.)

REFERENCES

LIST 3 PERSONS (AT LEAST 2 WHO ARE NOT RELATED TO YOU) WHO HAVE KNOWLEDGE OF YOUR EXPERIENCE IN WORKING WITH CHILDREN.

NAME

ADDRESS

PHONE

CAPACITY INWHICH PERSON KNOWS YOU

HAVE YOU EVER BEEN CONVICTED OF A CRIME?(Required)

Yes

No

IF YES, EXPLAIN