Camp Fire USA Eastern Massachusetts Council & Camp Nawaka, Camp Ponkawissett, Zoo Camp

Camp Staff Application Form

Personal

Gender	Male Female
Current Age	Under 18 18 or older 21 or older
Name
Last Name
Current Address
Address (line 2)
City, State, Zip
Current Address Valid until	permanent
Telephone
Best time to call?
Email Address
Permanent Address (if different from above)
Address
Address (line 2)
City, State, Zip

Which camp are you applying to?
Camp Ponkawissett Day Camp in Canton, MA	Zoo Camp Day Camp in Dorchester, MA	Camp Nawaka Overnight Camp in East Otis, MA

What camp position are you applying for?
Have you ever applied for employment with Camp Fire USA?	No Yes If so, when?
Can you provide proof of American Citizenship?	No Yes
Are there any reasons you may have difficulty performing any of the essential elements of the job for which you have applied?	No Yes If yes, please explain

Education

Level	Name of school	Major	Degree Granted	Years Attended
High School
College
Other

Employment for the past 5 years

(please indicate any employer you do not want us to contact and the reason for this request)

Dates	Employer	City, State, Phone	Nature of Work	Reason for leaving

Camp Experience

Dates	Camp	Director	City, State, Phone	Camper or Staff Position

References

(Please provide a reference form -[download here]- to 3 adults not related to you who have knowledge of your skills, character, etc. These should be mailed to CFUSA)

Name	Address (street, city, state, zip)	Telephone	Relationship

For each activity listed below, please indicate by checking the plain boxes for each activity you have experience/interest in and checking the red boxes for each activity you have experience leading/teaching

Answer each of the questions that follow in the spaces below. If you fill the space, keep typing and it will scroll to fit your answer.

1. Describe your experience working with youth:

2. What qualities do you posess that make you a great counselor (or position you are applying for):

3. Our conseling staff instruct all of our classes/program blocks. What classes would you want to teach from the list of activities above, for a two-week session?

Have you ever pleaded guilty or nolo contendere to any felony or (within the last five years) a misdemeanor, addmitted to sufficient facts concerning any felony or misdemeanor, been found guilty of any felony or isdemeanor, or been found to be a sexually dangerous person in Massachusetts or elsewhere? Yes No

If answering yes to the above question, please state all relevant facts as to the offenses charges, courts involved, sentences imposed, and all conditions of probation or parole currently in effect in the space provided below. Please note, nationwide criminal background check and sex offender registry check is required by Massachusetts law for all employees prior to employment.

By checking the box at the end of this paragraph and submitting my application, I authorize investigation of all statements herein and release Camp Fire USA Eastern Massachusetts Council Inc. (CFUSA), 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 made in writing and signed by the camp director at CFUSA. I also understand that untrue, misleading, or omitted information herien may result in dismissal, regardless of the time of discovery, by CFUSA. I authorize CFUSA to release any employment information necessary in order to provide references to future employers, and release CFUSA and all others from liability in connection with the same.

I agree

Arts & Crafts Basketry Pottery* Jewelry Origami Sculpture Papermaking Nature Crafts Painting Photography* Illustration Candle making Papier-mâché Other (please specify)	Outdoor Skills Fire Building Alt. Cooking Equipment Outdoor Cooking Maps & Compass Canoe Trips* Hiking Min. Impact Camping Backpacking trips* Survival Skills Knots & Lashing Fishing* Other (please specify)	Nature & Science Animal Identification Astronomy Bird identification Ecology Lessons Nature appreciation activities Tree identification Insect identification Ecology Geology Science Zoology Other (please specify)	Sports Archery* Fitness Basketball Football Yoga Soccer Tennis* Volleyball* Field Games Lacrosse* Field Hockey* Other (please specify)
Dance Hip Hop Stomp Ballet Tap Other (please specify)	Team Building Icebreakers Cooperative or New Games Challenge Course De-brief	Drama Acting class Drama Games Improv. Activities Play Directing Set Design Skits	Waterfront Canoeing* Water Games Sailing* Swimming ARC Swim Lessons*
Miscellaneous Creative Writing Journalism/Camp Newsletter Office Skills* Evening Program*	Please list any certifications (CPR, Lifeguard, etc.) along with exp. date: 1. 2. 3. If 21 years of age, do you have a valid drivers license? Yes No