Day Camp Staff Application

 PERSONAL INFORMATION  (please print)

Name _________________________________________________ 

Date __________________

Address ____________________________________________________

Social Security No. _______________________ 

Phone No. ____________________________

Have you ever been convicted of a crime (except minor traffic violation)?  __________. 

 If yes, please explain _________________________________________

Are you 18 years of age or older?  _______ 

Names of employees at this Washington Township with whom you are acquainted or related ____________________________________________________

EDUCATION

Type of School Name and Location of School   Graduated   Major Field of Study

                                                                                                (Yes or No)

High School          _______________  ________  ____________________

College/University________________  ________  ____________________

College/University _______________  _________  ___________________

Trade, Business or

Correspondence School___________  ________  ____________________

 EMPLOYMENT EXPERIENCE

Company Name ___________________________ 

Address _____________________________

Employed from _________ to __________  Starting rate  ___________ Final rate ___________

Position Held ________________________ Supervisor ________________________________

Describe your job duties _________________________________________________________

Why did you leave? _____________________________________________________________

Company Name __________________________

Address ______________________________

Employed from __________ to __________ Starting rate ___________ Final rate ___________

Position Held ________________________  Supervisor ________________________________

Describe your job duties _________________________________________________________

Why did you leave? _____________________________________________________________

Company Name __________________________

Address ______________________________

Employed from __________ to __________ Starting rate ___________ Final rate ___________

Position Held ________________________  Supervisor ________________________________

Describe your job duties__________________________________________________________

Why did you leave? _____________________________________________________________

Which of the above jobs did you like best and why? ___________________________________ ____________________________________________________________________________

How did you hear about this position?  ______________________________________________

State any additional information you think would be of interest to us in considering your application, including skills: ________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________ 

References: Please list three references [not friends or relatives] that have knowledge of your character, experience, and your ability to work with children.

Name:                                      Relationship:                                         Email:                      Phone:

1.___________________________________________________________________________

2.___________________________________________________________________________

3.___________________________________________________________________________

APPLICANT’S STATEMENT  (please read carefully before signing)

   I certify that the information contained in this application is true and complete to the best of my knowledge.  In the event of employment, I understand that false or misleading information given in my application or interviews may result in immediate discharge whenever it is discovered.

   I authorize the release of any and all information concerning my previous employment and education and any pertinent information that my previous employers or schools may have and release all parties from all liability for any damage that may result from providing the information to the Company.

   I understand that statements which may be contained in policies, handbooks, practices and other materials do not create any contract, expressed or implied, or guarantee of employment.  I understand that the Company has the unconditional and absolute right to modify, amend or terminate policies, practices, benefit plans and other Company programs as it sees fit.

   In consideration of my employment, I agree to conform to the rules, regulations and policies of the Company and agree that my employment and compensation may be terminated at any time, either by me or by the Company, with or without cause.   

   I have read and understand the foregoing four paragraphs and have voluntarily agreed to them.

SIGNATURE _______________________________________________  

 DATE _______________