I: General Information |
Name
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First
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Middle
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Last
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Position Applying For
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Other
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Present Mailing Address
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Street
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City
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State
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Permanent Mailing Address
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Street
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City
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State
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Phone
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Birthdate
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Yes, I am under 18 years of age |
Sex
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SS # |
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I am legal to work in the US Yes No |
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Contact Info
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Cell Phone
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Email
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Present Occupation
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(if not in school) |
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How did you hear about this position? |
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Please be specific
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II: Education |
High School |
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Dates Attended
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Did you graduate
Yes No |
College/
Seminary |
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Dates Attended
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Did you graduate
Yes No |
Other
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Licenses, certificates, etc
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Jewish Education |
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III: Work Experience
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Record ALL work experience, including jobs held while attending school. You may include any work performed on a volunteer basis. LIST MOST RECENT JOB FIRST. |
Employer |
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Dates Employed: |
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Address |
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Phone Number: |
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Job Title |
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Supervisor |
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State major responsibilities |
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Employer |
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Dates Employed: |
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Address |
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Phone Number: |
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Job Title |
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Supervisor |
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State major responsibilities |
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Employer |
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Dates Employed |
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Address |
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Phone Number |
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Job Title |
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Supervisor |
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State major responsibilities |
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List groups or organizations to which you belong. List leadership positions held, if any |
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List hobbies and interests |
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May we contact your present employer at this time? Yes No |
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Was your employment ever terminated involuntarily or were you ever asked to resign?Yes No |
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If yes please explain:
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Have you ever been arrested, charged, or convicted of sexual abuse of a minor or child molestation? Yes No |
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If yes please explain:
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IV: Skills |
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Rate the following activities as follows. (1) can teach as an expert. (2) can assist the teacher and assume some responsibility. (3) generally familiar. (4) unfamiliar |
Frisbee |
Board Games |
Israeli Dance |
Modern Dance |
Drama |
Arts and Crafts |
Jewelry Making |
Sewing |
Knitting |
Woodworking |
Song Leading |
Photography |
Basketball
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Soccer |
Street Hockey |
Golf |
Tennis |
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Yoga |
Red Cross W.S.I |
Fluent in Hebrew |
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Fluent in other languages |
C.P.R. training completed |
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Age Preference
(rank in order; 1,2,3 etc.)
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2.5-3 years old
3-4 years old
4-5 years old
6-8 years old
8-12 years old
13-14 years old |
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V: References
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List 3 references who could comment on your abilities and experience working with children.
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1. Reference Name |
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Address |
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Phone Number |
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2. Reference Name |
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Address |
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Phone Number |
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3. Reference Name |
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Address |
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Phone Number |
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VI: Applicant’s Certification and Agreement |
I understand that if I am hired I am required to abide by the rules and regulations of Camp Gan Israel at Chestnut Hill. I understand that I will be employed on an at-will basis, which means that I will be free to resign at anytime, and that camp Gan Israel at Chestnut Hill reserves the right to terminate the employment at any time, with or without cause regardless of the date of payment of my wages and salary.
The information I have supplied in this application or as part of the application process is true and complete. I understand that any false statements or significant omissions by me in the application or application process may be cause for dismissal if discovered at a later date.
I hereby authorize Camp Gan Israel at Chestnut Hill to investigate the information I have furnished on this application, as well as conduct a CORI background check.
Date: Initials: Agree: Yes No
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