|
Name
(Last)
(First)
(M. I.) |
Telephone number
(incl. area code) |
|
Home Address
|
Telephone number
(incl. area code) college and/or work |
|
College Address (until ________________) |
Cell Phone Number
(incl. area code) |
|
E-Mail Address |
Are You At Least 16
Years of age?
YES
NO |
|
Type of Position
Applied For: Volunteer Paid Full Time Paid Part Time |
Are You 18 years of
age or older? yes no |
If part time or volunteer, days and time available: ____________________________
U.S. Citizen? ___________Visa type, if not a U.S. Citizen? ____________________________
Military Service? ________Yes ________No From __________
to __________
Dates Available for Interview? _________________________________________________
Education:
| School Name: |
| Location: |
| Major: |
| Dates
Attended:
From:
To: |
| Year Graduated: |
| High School: |
| College or University: |
References Personnel:
1._______________________________________________________________________________
Name
Position
Area Code
Telephone
_________________________________________________________________________________
Street
Address
City
State
Zip Code
2.________________________________________________________________________________
Name
Position
Area Code
Telephone
__________________________________________________________________________________
Street
Address
City
State
Zip Code
3._________________________________________________________________________________
Name
Position
Area Code
Telephone
___________________________________________________________________________________
Street
Address
City
State
Zip Code
Position
Desired Check
Desired Positions
_____ Aquatics Director
_____ Life Guard
_____ Outdoor Living Skills
Instructor
_____ Recreation Instructor
_____ Boating/Canoeing
Instructor
_____ Arts and Crafts
Instructor
_____ Shooting Sports
Instructor
_____ Outdoor Education Instructor
_____ Food Service Director
_____ Kitchen Assistant
_____ Day Camp
Coordinator
_____ Day Camp
Counselor
|
Interests,
Skills, and activities Please mark
a "1" beside those you can teach or lead; mark a "2" beside those with
which you can assist; mark a "3" beside those which you are interested
in learning. |
Current Certifications/
licenses/Training |
|
|
Crafts Outdoor
Living Skills Adventure
Skills Sciences Program |
Waterfront Drama Music Sports Animals
|
_____
Standard/ Advanced First Aid
_____ _____
Wilderness First Aid
______ _____ CPR -
Adult
______ _____ CPR -
Child
______ _____ EMT
(State: )
______ _____RN (State: )
______ _____
Lifeguard Training
______ _____ Water
Safety Instructor
______ _____ Shooting Sports ______ _____ Ropes
Course Training
______
*Please Describe (High or low, Sponsoring Agency, Length
of Course) *_______________________________________ Other:
(Societies, Awards, Publications and Associations) _____ _________________________ ______ _____ _________________________
______
|
Please answer the following questions giving
careful consideration to each.
If extra space is needed attach another sheet of paper.
1. How did you learn about Camp Whitewood?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
2. Why do you want to work at Camp Whitewood?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
3. How do you feel your present values and lifestyle agree with the
camp's philosophy
"The Mission of N.E.O. 4-H Camps Inc. is the
educational development of positive and productive life skills
accomplished through
group interaction the unique natural environment of the Whitewood
campus." and,
by priority, list the three most important values of your life
and
why.
_______________________________________________________________________
________________________________________________________________________
1._____________________________________________________________________
2._____________________________________________________________________
3.
_____________________________________________________________________
4.. What contributions can you make to help camp fulfill its goals
and
objectives?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
5. Please describe your previous experience and /or training
in working with children?
_______________________________________________________________________
________________________________________________________________________
________________________________________________________________________
6. As a staff member, it is essential that you be a postive
role model for our campers. How will
you provide such leadership?
________________________________________________________________________
________________________________________________________________________
Any physical conditions which may limit your ability to perform work applied for?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Have you ever been convicted of a crime?___YES___NO If yes,
describe in full detail.
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Volunteer Experience
__________________________________________________________________________________
Agency
Area Code Telephone Number
__________________________________________________________________________________
Street
City
State
Zip Code
__________________________________________________________________________________
Supervisor's
Name
How long there?
__________________________________________________________________________________
Duties
__________________________________________________________________________________
__________________________________________________________________________________
Agency
Area Code Telephone Number
__________________________________________________________________________________
Street
City
State
Zip Code
__________________________________________________________________________________
Supervisor's
Name
How long there?
__________________________________________________________________________________
Duties
__________________________________________________________________________________
List others on separate sheet of paper.
List Most Recent Work Experience
List present employer (or current) first. You do not need
to
provide a detailed list of duties and responsibilities if described in
an
attached resume.
1.________________________________________________________________________________
Company
Name
Your Title
__________________________________________________________________________________
Company
Address
City
State
Zip Code
__________________________________________________________________________________
Date
Started
Date
Left
Starting
Salary
Ending Salary
__________________________________________________________________________________
Supervisor's
Name
Area Code
Telephone
__________________________________________________________________________________
Descriptions of duties and responsibilities.
__________________________________________________________________________________
Reason for leaving
__________________________________________________________________________________
May we contact this employer? Yes ______ No ______
2.________________________________________________________________________________
Company
Name
Your Title
__________________________________________________________________________________
Company
Address
City
State
Zip Code
__________________________________________________________________________________
Date
Started
Date
Left
Starting
Salary
Ending Salary
__________________________________________________________________________________
Supervisor's
Name
Area Code
Telephone
__________________________________________________________________________________
Descriptions of duties and responsibilities.
__________________________________________________________________________________
Reason for leaving
__________________________________________________________________________________
May we contact this employer? Yes ______ No ______
3._________________________________________________________________________________
Company
Name
Your Title
__________________________________________________________________________________
Company
Address
City
State
Zip Code
__________________________________________________________________________________
Date
Started
Date
Left
Starting
Salary
Ending Salary
__________________________________________________________________________________
Supervisor's
Name
Area Code
Telephone
__________________________________________________________________________________
Descriptions of duties and responsibilities.
__________________________________________________________________________________
Reason for leaving
__________________________________________________________________________________
May we contact this employer? Yes ______ No ______
Applicant’s
Statement
The
information contained in this application is correct to the best of my
knowledge. I authorize any references or
organizations listed on this application to give you any information
they may
have with regard to my ability and fitness to work with youth. I release such references from any liability
for providing such evaluations, provided they do so in good faith. I waive any right that I may have to inspect
references provided on my behalf.
Signature
________________________________________________ Date
_____________________
If applicant is
under 18, parent or legal guardian must also sign this application. Signature indicates application is made with
full approval on your part.
Parent Signature
_________________________________________ Date
_____________________
Please return this application to:
4-H Camp Whitewood
Personnel Office
7983 S.Wiswell Road
Windsor, Ohio 44099
For
More Information:
Call (800) 967-2267
(440) 272-5275
Fax(440) 272-5276
e-mail: cbellina@ag.osu.edu
web site: http://www.ag.ohio-state.edu/~wwood4h/
page
updated January 2008