Cody 2007 Staff / CIT Application Form

Family Name: First Name: Nickname:
Permanent Address:
City State Postal Code Country
Permanent Phone: Fax (if applicable):
E-mail:
Current Mailing Address:
City State Postal Code Country
Current Phone: Fax (if applicable):
Date of Birth (optional) Citizen of what country:

EDUCATION
DATES SCHOOL AND ADDRESS MAJOR SUBJECTS
YRS COMPLETED

PAST EMPLOYMENT
DATES EMPLOYER SUPERVISOR
ADDRESS AND PHONE NUMBER

CAMP EXPERIENCE
DATES CAMP DIRECTOR
ADDRESS AND PHONE NUMBER

PERSONAL DETAILS
Are you over 18? Are you over 21?
Do you hold a current driver’s license? Number of years driving State
Do you have a clean driving record? License #
Do you speak a foreign language? which?
Until what date are you available to work?
What dates and times are you available for an interview?
Do you have any personal needs or concerns that may affect your work or health or lifestyle as pertains to summer camp employment? If yes explain

SKILLS
In the section below please rank activities according to your level of experience. mark‘1’ beside activities for which you have advanced skills and/or certification; ‘2’ for activities you can instruct confidently; and ‘3’ for activities for which you can assist.
TEAM & INDIVIDUAL SPORTS INDIVIDUAL ACTIVITIES
Baseball 1 2 3 Photography 1 2 3
Basketball 1 2 3 Computers 1 2 3
Soccer 1 2 3 Theatre 1 2 3
Hockey 1 2 3 Dance 1 2 3
Football 1 2 3 Nature/Ecology 1 2 3
Volleyball 1 2 3 Team Building 1 2 3
Lacrosse 1 2 3 Community Service 1 2 3
Track/Field 1 2 3 Ropes Course 1 2 3
Archery 1 2 3 Newspaper 1 2 3
Team Building 1 2 3    
Tennis 1 2 3    
Riflery 1 2 3    
CAMP CRAFT/BACKPACKING WATERFRONT ACTIVITIES
Trip Leading 1 2 3 Windsurfing 1 2 3
Hiking 1 2 3 Powerboat driving 1 2 3
Woodcraft 1 2 3 Water-skiing 1 2 3
Campouts 1 2 3 Sailing 1 2 3
Backpacking 1 2 3 Swimming 1 2 3
Leave No Trace 1 2 3 Kayaking 1 2 3
  Lifeguarding 1 2 3
CRAFTS Water Polo 1 2 3
Arts & Crafts 1 2 3 Snorkeling 1 2 3
Pottery 1 2 3 Scuba Diving 1 2 3
Woodworking 1 2 3 Canoeing 1 2 3
Model Rocketry 1 2 3    
SUPPORT SERVICES FOOD SERVICE  
Maintenance 1 2 3 Chef/cook 1 2 3
Carpentry 1 2 3 Salad Bar 1 2 3
Laundry 1 2 3 Baker 1 2 3
Cleaning 1 2 3 Dishwasher 1 2 3
Grounds 1 2 3    
Canteen/Camp Store 1 2 3    
OFFICE/CLERICAL MEDICAL  
Receptionist 1 2 3 Nurse 1 2 3
Word-processing 1 2 3 EMT 1 2 3
Typing 1 2 3    
Databases 1 2 3    
Web design 1 2 3    
Accounting 1 2 3    
Bookkeeping 1 2 3    

CHECK OFF ANY OF THE FOLLOWING QUALIFICATIONS YOU CURRENTLY HOLD
Red Cross Lifeguarding Expires
Red Cross Water Safety Instructor (WSI) Expires
Red Cross First Aid Expires
Red Cross or American Heart Association CPR Expires
Wilderness First Aid (WFA) Expires
Wilderness First Responder (WFR) Expires
EMT Expires
Ropes Course Certification Expires
PADI/NAUI Scuba Instructor Certification Expires
Commercial Boat Driving License Expires
Teaching Certification Expires
National Riflery Association Riflery Instructor Expires
Archery Instruction Certification Expires

WHICH ACTIVITIES WOULD YOU LIKE TO TEACH? Be aware that you may end up with your 3rd choice. Only list activities you would enjoy and be enthusiastic to teach/perform.
1. 2. 3.

PLEASE DESCRIBE YOUR QUALIFICATIONS AND EXPERIENCE FOR THOSE ACTIVITIES YOU WISH TO INSTRUCT:

PLEASE DESCRIBE YOUR EXPERIENCE WORKING WITH CHILDREN:

PLEASE DESCRIBE LEADERSHIP POSITIONS YOU HAVE HELD IN THE PAST:

WHAT DO YOU BELIEVE ARE THE MOST IMPORTANT OBJECTIVES OF A SUMMER CAMP?

WHAT MAKES YOU AN OUTSTANDING CANDIDATE FOR EMPLOYMENT AT CODY? WHAT WILL YOU ADD TO CODY?

REFERENCES Please list people who know you well and who can speak on your character, your candidacy for working with children and/or your expertise in the selected activities. Do not include relatives. Applications will not be considered without appropriate references.
Name Title/Position Complete Address Phone number

REFERENCE AND BACKGROUND CHECKS
As an applicant for a position at Cody I give permission for all previous employers, friends, family and any others, to give a reference on my behalf to Cody. I also freely agree that the providers of any and all information and record to Cody will be held harmless by me regardless of its content, and that such information will become part of my personal application for employment at Cody. Further, I understand that employment at Cody requires that I provide, and/or agree to have provided for me, a criminal background check. I authorize the release of information pertaining to my background including, but not limited to, information as to my employment, education, military service, driving record, criminal record and/or public records to those employees of Cody who require such information in order to make a decision with respect to any matter pertaining to my status as an employee.

I hereby release Cody, its employees and anyone acting on behalf of Cody from any and all claims, liability and/or damage of any nature which may result from furnishing the information requested, including, but not limited to claims of negligence.


DATES OF EMPLOYMENT:
Cody involves a nine week commitment beginning June 17 and ending August 18, 2007. Cody requires most staff to have current CPR and First Aid Certifications. If you require CPR, First Aid or Lifeguard Certification you must arrive one week earlier, no later than June 10, 2007. All waterfront staff must hold current Red Cross Lifeguard Certification. If you do not acquire or update certifications before June 10, you must do so at Cody. Cody provides this training free of charge.

AUTHORIZATION
I have read and understand the policies and procedures of employment at Cody. I certify that the information I have provided on this application is true and complete to the best of my knowledge. I understand that an omission or misrepresentation of any fact or circumstance in my application, resume, or any other materials I have completed of submitted or made during any of my interviews may be justification for refusal of employment or, if employed, termination of employment and possible prosecution.

I understand that employment with Cody is ‘at will’ and that if I am hired my employment and compensation can be terminated with or without cause or notice, at any time, for any violation of contract, at the discretion of Cody.

All statements given by an applicant become part of any future employment contract at Cody. The applicant affirms that he/she has no history of, nor has he/she ever been prosecuted for, or convicted of, child abuse, sex abuse, or drug addiction. By signing and returning this application to Cody, you agree to all the terms and conditions of employment.


  
 


Cody Camps
9 Cody Road
Freedom, NH 03836
(800) 399-4436 or (603) 539-4997

info@codycamps.com