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Staff Online Application

Complete the form below. Be sure to verify all information is accurate before clicking submit.

General Information
Last Name: First Name: Middle Name:
Permanent Address:
City: State: Zip:
College Address:
City: State: Zip:
phone (day): phone (night): phone (college/shore): phone (cell):
Optional:
Date of Birth: Marital Status: Sex and Ages of Children: Email:
enter "none" if you do not use email
Education & Training
School Name Major Year Degree Graduation Yr.
High School
College
Post Graduate
other
Camping Experience List Camper Experience
Camp Name City/State Dates Attented Comments
List Camp Staff Experience
Camp Name City/State & Phone Dates Attented Position/Salary
Past Employment (Please list previous two summers or years)
Dates Employer City/State Phone Position Supervisor Reason for Leaving
References  List former employers, especially those in camping, teaching, babysitting clients, and instructors. Do not list relatives or friends.
Name Address Relationship Phone Number
For what position are you applying? Bunk Counselor applicants indicate age preferred.   
Salary requirements to accept this position.   
With what age groups have you had experience?   
For the following list, put numeral "1" before those activities you can organize and teach as an expert; "2" for those activities in which you can assist; and, "3" for those which are just your hobby.
Arts & Crafts Music Outdoors Sports Water
Basketry Singing Camp Craft Archery Canoeing
Ceramics Instruments Hiking Badminton Diving
Gymp Bugle Orienteering Baseball Kayaking
Jewelry Drums Outdoor Cooking Basketball Life Saving
Leather Craft Guitar Camping Fencing Rowing
Metal Work Piano Scouting Field Hockey Swimming
Nature Crafts Other Fishing Other
Painting Golf
Photography Dance Nature Gymnastics Misc
Printing Ballet Nature Hockey Cheerleading
Sign Painting Disco Animals Horseback Riding Climb Tower
Sketching Folk Astronomy Lacrosse Color War Leader
Weaving Social Birds Mini Golf Cooking
Woodworking Square Conservation Ping Pong First Aid
Tap Flowers Roller Blading Games
Computers Aerobics Forestry Roller Skating Rocketry
PC Insects Soccer Ropes Course
MAC Drama Other Softball Stories
Internet Directing Tennis Yearbook
Do you hold American Red Cross Certification as a Lifeguard or Water Safety Instructor (WSI)?   yes   no
Indicate any condition or circumstance that might prevent you from, fully, carrying out the responsibilities of your position.   
List teaching, coaching, scouts, leadership or other experiences that will support your application. Example: CIT Diploma, Tall Pines Day Camp, NAA Accredited Instructor.  
Have you ever been convicted of a crime?  yes   no
COMMITMENTS REQUIRED FOR EMPLOYMENT
Willing and able to teach swimming daily in the water. (Lifeguard certification not required.) yes  no
Willing to attend a minimum of two pre-season in-service meetings. Dates and times TBA. yes  no
Willing to accept any age group or specialty area as assigned by the camp. yes  no
Available for the entire season and willing to make arrangements to deal with personal problems before or after camp. yes  no
I hereby give permission for my employment record and references to be checked by an outside Reporting agency. If you wish to withhold this permission, please explain why.   yes  no
AUTOMOBILE INFORMATION - SENIOR STAFF ONLY (College age and above)
Will drive a car route as assigned and accept changes in route that are necessary and reasonable. yes  no
Will provide $100,00/$300,000 liability insurance at personal expense. yes  no
(Insurance for van driver's provided at camp's expense. Camp automobile insurance permits you to drive campers and staff and completely covers the driver and owner of the vehicle. Our insurance agent investigates all driving records.
Year  Make  Model  No. of Seatbelts
No. of Airbags         Driver's License Number
and State .  

Is the license valid at this time? yes  no.
Have you, or are you, being charged with a motor vehicle violation or accident that may result I the loss of license?  yes  no.
If yes, explain

By checking the box below and clicking submit, I authorize any previous employer, law enforcement agency, governmental entity or any other person to release any and all information about me to Tall Pines Day Camp which they may request. I hereby waive any privilege to said information, or any rights of cause of action I may have pertaining to the release of information authorized herein. The information presented is truthful and accurate to the best of my recollection. Applicant may opt not to answer any and all questions.
Check here if you have completed the form above.