* REQUIRED
Camp Jefunira Staff Application Form
First: * Last: *
Nickname: E-mail address:*
Primary Phone:* Cell Phone:
Address: City:
State Zip:
SSN#    
School Address : City:
State Zip:
Past Work History Provide a full record of all employment — paid and volunteer — and explain any gaps in employment. Include any positions on camp staff.
Employment 1
Dates Employer
Address Supervisor
Phone Nature of Work
Reason for Leaving    
Employment 2
Dates Employer
Address Supervisor
Phone Nature of Work
Reason for Leaving    
Employment 3
Dates Employer
Address Supervisor
Phone Nature of Work
Reason for Leaving    
Work History Gap Explanation:    
   
Indicate any employer you do not wish us to contact, and the reason:
Past Camp History Provide a full record of all employment — paid and volunteer — and explain any gaps in employment. Include any positions on camp staff.
Camp 1
Dates Camp Name
Address Director
Phone Camper or Staff
Camp 2
Dates Camp Name
Address Director
Phone Camper or Staff
Camp 3
Dates Camp Name
Address Director
Phone Camper or Staff
References: Please list 3 individuals (non-family members) who are familiar with your talents and your work with children:
    Name       Phone   Relationship
Reference 1.
Reference 2.
Reference 3.
Education: Please list all educational institutions attended:    
   School    Graduation Date Diploma/Degree
High School
College
Graduate Work
Personal Information : Please answer the following questions. Feel free to add any additional information you think will help us come to know you better.

1. Tell us a bit about yourself and why you want to work at Jefunira Camp.

2. Working at Jefunira camp is a lot of fun, but it's also hard work. As a counselor you’ll have responsibility for and supervision of campers the entire time they’re at camp in addition to set-up and clean up chores every day.  Tell us about your character/personality traits that will allow you to meet these expectations for the full 8 weeks.
3. Describe your prior experiences working with children. What did you learn about working with kids?
4. What special talents, skills and/or interests will you bring to Jefunira Camp and how could you use them to entertain kids?
5. Tell us an interesting fact or story about yourself that illustrates why you would be a good camp counselor.
6. How did you hear about working at Jefunira Camp?:
7. Finally, do you have any questions that you would like to ask us?
Criminal Record Have you ever been convicted of a crime, other than a minor traffic offense? If yes, please describe. (Note: a prior conviction is not an automatic bar to employment. The type of conviction and when it occurred will be evaluated by the camp before any decision is made.) No Yes
If yes, explain:
Harassment The camp’s policy is to prohibit all forms of harassment by our employees. This includes sexual, racial, religious, and other forms of harassment. Have you ever been accused of harassment of any person including, but not limited to, workplace harassment? (Note: a prior accusation is not an automatic bar to employment. The type of accusation and when it occurred will be evaluated by the camp before any decision is made.) No Yes
If yes, explain:
Agreement
All statements become part of any future employee personnel files.I authorize investigation of all statements herein, including any checks of criminal records, and release the camp and all others from liability in connection with same. I understand that, if employed, I will be an at-will employee unless there is an agreement or law which alters that status. Furthermore, I understand that any agreement must be in writing and signed by the designated camp official. I also understand that misrepresentations or falsifications herein or in other documents completed or submitted by the applicant will result in dismissal, regardless of the date of discovery by the camp.
Signature: Check box for acceptance of all terms of this form: