Lakeview Day Camp : Apply Now!

Required fields are marked (*)

First Name*

Last Name*

Nickname


Gender	Marital Status	Date of Birth

CONTACT INFORMATION
Address
City	State	Zip

Home Phone	Work Phone	Cell Phone	School Phone


Email*


Social Security # (xxx-xx-xxxx)		Drivers License #

POSITION DESIRED (check all that apply)

Counselor

Division Leader

Aide

Specialist

Office

Swim/Waterfront Instructor

Maintenance

Other

GRADE PREFERENCE (check all that apply)

Preschool / K

1st / 2nd / 3rd

4th / 5th / 6th

Teen Travel

Would you be interested in supervising or driving a camp mini-bus? Yes No
(To drive a bus you must be 21 years of age)

CURRENT OCCUPATION
	I am a full time student

EDUCATION

GRADUATE SCHOOL
School Name	Location

Area of Study

Current Year Fresh Soph Junior Senior Graduated

Year graduated (or expected year of graduation)

COLLEGE
School Name	Location

Area of Study

Current Year Fresh Soph Junior Senior Graduated

Year graduated (or expected year of graduation)

HIGH SCHOOL
School Name	Location

Current Year Fresh Soph Junior Senior Graduated

Year graduated (or expected year of graduation)

Activities, clubs, organizations, hobbies or special interests.

WORK HISTORY Please list your most recent employment, especially in camping or involving children.
1.	Employer	Employed from	to
	Position	Reason for leaving
2.	Employer	Employed from	to
	Position	Reason for leaving
3.	Employer	Employed from	to
	Position	Reason for leaving

PREVIOUS CAMP EXPERIENCE
1.	Camper Staff	Camp	Location
	Dates of attendance	to	Role (if a staff member)
2.	Camper Staff	Camp	Location
	Dates of attendance	to	Role (if a staff member)
3.	Camper Staff	Camp	Location
	Dates of attendance	to	Role (if a staff member)

REFERENCES Please provide three references (employers, teachers, supervisors - *not* friends, family or neighbors).
1.	Name of Reference	2.	Name of Reference	3.	Name of Reference
	School/Company/Org.		School/Company/Org.		School/Company/Org.
	Relationship		Relationship		Relationship
	Contact #		Contact #		Contact #

SKILLS & EXPERIENCE
Here is a sampling of activities at LakeView. Please list the ones you can either teach, assist or enjoy (feel free to add any other activities you think would be fun for camp!):

Sports: Archery, Basketball, Baseball/Softball, Cheerleading, Dance, Football, Golf, Gymnastics, Hockey, Martial Arts, Lacrosse, Skateboarding, Soccer, Tennis, Volleyball, Yoga/Pilates…

Outdoor Adventure: Rock Climbing, Go-Karts, Mountain Biking, Nature, Orienteering, Pioneering, Plants / Trees, Rappelling and Belay, Camping, Fishing, Ropes Course, Teamwork and Initiatives Games, Caring for Animals, Environmental Education…

Swim and Lakefront: WSI, Lifeguarding, Swim Instruction, Boating, Canoeing, Kayaking, Sailing…

Creativity: Arts and Crafts, Ceramics, Cooking, Jewelry, Mad “fun” Science, Painting, Rocketry, Tools and Technology, Woodworking…

Performing Arts: Play Directing, Technical Theater, Storytelling, Camp Song Leading, Comedy, Drama/Theater…

I can teach:

I can assist:

I enjoy:

Briefly describe why you want to work at LakeView Day Camp this summer?

What personal qualities or characteristics will make the biggest impression on our campers and staff?

CERTIFICATION Please check any current certifications with their expirations dates.
	Date Issued	Expiration Date
Red Cross WSI
YMCA Lifeguard
Red Cross Lifeguard
Red Cross Waterfront
Certified Pool Operator (CPO)
CPR
Standard First Aid
Advanced First Aid
Response to Emergency (RTE)
EMT
Registered Nurse (RN)
Epi-Pen
Certified Teacher
Ropes Courses / Belaying
Archery
Commercial Drivers License (CDL)
Other
Other
Other

Did anyone recommend you to us? Yes No

If yes, please include the person's name

CHILDREN AT CAMP
Do you have children who attend or who you would like to attend LakeView?	Yes No

Current Ages?

Have you ever been convicted of a crime or misdemeanor?* Yes No

If yes, please explain in detail

2010 CAMP SEASON: Monday, June 28th through Friday, August 20th

Do you have any conflicts with the above dates?* Yes No

If yes, briefly explain

As of this date, are you under contract with any other camp?* Yes No

By typing "AGREE" below and by electronic submission of this application:

•	I certify that all the statements and information on this application are accurate and complete, and I understand that any employment offers are based upon the accuracy of this information. I authorize LakeView Day Camp to investigate all statements contained in this application. If I am hired for a position at LakeView I understand that any false statements, omissions or inaccuracies of this application may cause my dismissal.
•	Employment is contingent on successful referral and background checks. I authorize LakeView Day Camp to perform full referral and background searches.
Please type "AGREE" here* (all CAPS please!)