Summer Staff Application Please Type or Print

Return Application to: Spring Heights Education Center2067 Barrcut Rd.Spencer, WV 25276 Or email to: info@springheights.org(304) 927-5865

PROFILE

Date of Application:

Name:

Date of Birth:

Permanent Address:

Phone:

Email:

School/Business Address:

School/Business Phone:

Position(s) Applied For:

|_| Counselor

|_| Program Assistant

|_| Lifeguard

|_| Maintenance

|_| Kitchen

Dates Available: FROM TO

Salary Desired:

Are you available for an interview?

Where?

Are you a citizen of the United States?

YES |_|

NO |_|

If no, are you authorized to work in the U.S.?

YES |_|

NO |_|

Have you ever worked here before?

YES |_|

NO |_|

If so, when?

Have you ever been convicted of a felony?

YES |_|

NO |_|

If yes, explain

Church Name and Address: Pastor:

Recent Involvement at Church:

Education

Years

School

Major

Degree Granted

Past Employment (List previous two summers or years)

Dates

Employer

Address/Telephone

Nature of Work

Supervisor

Reason for Leaving

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CAMP EXPERIENCE

Dates

Camp

Address/Telephone

Director

Camper or Staff?

In the following list, put the numeral 1 before those activities you can organize and teach as an expert; 2 before those activities in which you can assist in leading; and 3 before those which are just your hobby.

Adventure/Challenge

___ Climbing/Rappelling

___ Ropes Course

___ Spelunking

___ Cycling

Arts and Crafts

___ Basketry

___ Ceramics

___ Jewelry

___ Leather Work

___ Macram

___ Metal Work

___ Nature Crafts

___ Painting

___ Sketching

___ Weaving

___ Woodworking

Camp Craft/Pioneering

___ Camp craft

___ Hiking

___ Orienteering

___ Outdoor Cooking

___ Overnight

___ Mountaineering

___ Min. Impact Camping

Drama

___ Creative

___ Play Directing

___ Skits and Stunts

Music

___ Lead Singing

___ Instrument (List Below)

___________________

___________________

Nature

___ Animals

___ Astronomy

___ Birds

___ Conservation

___ Flowers

___ Forestry

___ Insects

___ Rocks & Minerals

___ Trees & Shrubs

___ Weather

___ Gardening

___ Animal Care

Sports

___ Baseball

___ Basketball

___ Fishing

___ Informal Games

___ Riding

___ Soccer

___ Softball

___ Tennis

___ Track & Field

___ Volleyball

___ Wrestling

Waterfront Activities

___ Canoeing/Kayaking

___ Diving

___ ARC/WSI

___ ARC/EWS

___ BSA/Aquatic Instructor

___ YMCA/Lifeguard

___ Rowing

___ Sailing

___ Swimming

___ Rafting

Miscellaneous

___ Standard First Aid Cert.

___ Advanced First Aid Cert.

___ CPR

___ Campfire Programs

___ Carpentry

___ Evening Programs

___ First Aid

___ Storytelling

___ Word Processing

___ Worship Services

___ Language

___ Bible Study

___ Photography

___ Darkroom

___ Newspaper

What talents do you have that will be an asset to the camp program?

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What special training or experience do you have for this position?

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

REFERENCES (3 persons unrelated to you that have knowledge of your character, experience, and ability)

Name

Address

Telephone

I authorize investigation of all statements herein and release Spring Heights Education Center and all others from liability in connection with the same. I understand that, if employed I will be an at-will employee and that any agreement to the contrary must be in writing and signed by the director of the camp. I also understand that untrue, misleading, or omitted information herein may result in dismissal, regardless of the time of discovery by the camp.

Signature ______________________________________ All statements become a part of any future employee personnel files.

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