Camp Fire River Bend is hiring: Camp Fire After School Program Staff

Birthday *

All applicants must be at least 16 years of age

Home Address *

City *

Zip / Postal Code *

Street *

Please detail your skills and relevant experience for the position(s) you are applying for.

Certifications (Please mark all areas in which you are currently certified, and indicate expiration date(s) below). You will need to provide a photocopy of all certifications if you are hired.

Adult CPR

Child CPR

CPR-PR/AED (professional rescuer)

First Aid

Please list expiration dates for all certifications you marked above.

Have you ever been arrested? *

Yes

If yes, please explain

Have you ever been accused of or involved in an incident involving sexual or physical abuse of a child? *

Yes

If yes, please explain

Is there any reason, medical or otherwise, that would prevent your full participation in our program? *

Yes

If yes, please explain

What’s your citizenship / employment eligibility? *

Personal Reference #1: Name *

YOUR REFERENCES MUST SUBMIT A CONFIDENTIAL REFERENCE FORM (http://tiny.cc/campref). References must be ADULTS who know you well, and they may NOT be relatives, roommates, best friends, or other Camp Fire Staff.

Personal Reference #1: Phone Number *

Personal Reference #1: Email address

Personal Reference #2: Name *

Personal Reference #2: Phone Number *

Personal Reference #2: Email address

Personal Reference #3: Name *

Personal Reference #3 Phone Number *

Personal Reference #3: Email address

Employment History #1: Job Location

Please provide information on your most recent 3 (if applicable) positions, beginning with the most recent (Employment History #1).

Employment History #1: Your job responsibilities

Employment History #1: Supervisor's Name

Employment History #1: Supervisor's Phone Number

Employment History #1: Dates Employed

Employment History #1: Reason for leaving

Employment History #1: May we contact this employer?

Yes

Employment History #2: Job Location

This should be your 2nd most recent position

Employment History #2: Your job responsibilities

Employment History #2: Supervisor's Name

Employment History #2: Supervisor's Phone Number

Employment History #2: Dates Employed

Employment History #2: Reason for leaving

Employment History #2: May we contact this employer?

Yes

Employment History #3: Job Location

This should be your 3rd most recent position

Employment History #3: Your job responsibilities

Employment History #3: Supervisor's Name

Employment History #3: Supervisor's Phone Number

Employment History #3: Dates Employed

Employment History #3: Reason for leaving

Employment History #3: May we contact this employer?

Yes

Please describe your experience working with children. *

Why do you want to work in an After School program? What do you hope to gain from this experience? *

What are your hobbies, interests, and skills that you feel would help you in this position? *

I have read and understand Camp Fire’s Personnel Policies and Procedures (https://docs.google.com/document/d/1uiHZOPcvkpBmWgATvOpGbuenHScRkv4E8eS_F7foJNA/edit?usp=sharing). By signing this application, I affirm that the information I have provided is true and correct. *

Please type your name to digitally sign this statement.