Prospective Staff - Information Form
Name
*
Position appling for:
*
Part-Time
Internship (14-week, stipend)
Volunteer (Min. 3 hrs weekly)
Which describes you
Please Select
College graduate and over 21 years old
College student and over 18 years old
Self-employed or Stay-at-Home parent
Retired
None describes me
Cover Letter
*
Upload Resume. (*.doc or *.pdf)
Upload a File
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Address
City
State
Zip
E-mail
*
Phone (Cell)
*
Phone (other)
Do you have a Skype account? Initial interviews may be conducted over Skype (free service)
Yes
No
Skype User Name
I have a good driving record (i.e. positive points in Virginia)
*
Yes
No
I am willing to drive my personal vechical for work related duties.
*
Yes
No
I can pass a criminal background and CPS search.
*
Yes
No
I understand that part-time staff work "on-demand" based on program needs and my own level of training?
Yes
No
Days of week I am able to work
*
Weekdays
Weekends
Anytime
Comments on ablity to work (times, days, restrictions, etc.)
Which activites do you have significant expereince with?
Canoeing
Sea Kayaking
Bicycling
Mountain Biking
Hiking / Trekking
Backpacking
Camping / Tents & Car
Orienteering
Running
Ropes Courses
Group Initiatives
Group Facilitation
Fitness Training
Other
If "other," then describe
Pick one of the activities from above and describe how it could be benefitical to youth.
What trainings / certs. do you have?
ACA (Kayak L2+)
ACA (Other)
ACCT
AMGA
MBIA
1st Aid
CPR
EMT
WFR
WEMT
Other
If "other," then describe
Briefly describe your expereince working with youth (9-18 yrs).
Describe one way you are improving yourself physically, emotionally, or mentally. What is the benefit to you?
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