Returning Staff
Yes
No
First
Name
Last
Name
Gender
Male
Female
Birth
Date
Age
as of 6/30/02
Grade
Completed
as of 6/02
Social
Security #
School
Attending
Home
Address
City
State
Zip
Code
Phone
Number
E-Mail
Address
College
Address (if applicable)
City
State
Zip
Code
Phone
Number
E-Mail
Address
Educational
Background:
High
School
Dates
Attended
College/University
Dates
Attended
Area
of Study
Please
List and Explain any Leadership Experience You Have Had
References
(List 3)
Reference
#1
Address
Phone
Number
Name
Address
Phone
Number
Reference
#2
Address
Phone
Number
Reference
# 3
Address
Phone
Number
Group/Area
Preference
Ruth/Moses (3rd-5th Grade)
Rebecca/Dan (6th & 7th Grade)
Leah/Abe (8th & 9th Grade)
Specialty
Health Center
Kitchen
Pool
Office
Maintenance
If
You Chose "Specialty," Which Activity Would You Prefer?
If
You Chose "Pool,"
Please Indicate Appropriate Certification
Information:
Lifeguard Training
Expires
Basic Life Support
Expires
Water Safety Instruction
Expires
CPR
Expires
First Aid
Expires
Do
You Have Any Physical Limitations or Illnesses?
Yes
No
If
Yes, Please Explain
Are
You a Smoker?
Yes
No
Do
You Have Any Special Dietary Needs?
Yes
No
If
Yes, Please Explain
Have
You Ever Been In an Incident Involving the Sexual or Physical
Abuse of Children?
Yes
No
If
Yes, Please Explain
Have
You Ever Been Convicted of a Felony or Misdemeanor
Yes
No
If
Yes, Please Explain
Please
Give Careful Thought to the Next Few Questions:
If
you ever attended a Residential/Sleepaway Camp, Please Give the
Name and Location
Some
Experiences With Children That I Have Enjoyed Are:
Elements
That I Find Essential to Building a Positive Community:
Challenges
That I Anticipate Facing While Working as a Counselor:
Personal
Strengths That I Anticipate Utilizing at Camp:
I
Hope To Work At Camp Edward Isaacs in Order to Gain:
My
Most Significant Jewish Experience Was:
Special
Interests, Talents, Sports Skills, Hobbies, and Other Information:
By
Submitting This Application I Attest That ALL the Information
Contained Herein is True and Factual
Yes
No