Five Star Life Application 2022-2023

Five Star Life - Summit Application 2023
Select Type of Application (must choose 1)*

Volunteer ApplicationBasketball Coach ApplicationJob Application
Date of Basic Training
Date of Predator Training
Number of References Submitted
Basic Information
Full Name*

First NameMiddle NameLast Name
Today's Date

MonthDayYear
Date
Have you submitted a Five Star Life Application before?*

YesNo
Have you previously Coached Five Star Life Basketball?

YesNo
How did you hear about us? blanks
Birth Date*

MonthDayYear
Calculation
Gender*
Phone Number*
E-mail*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Parent/Guardian E-mail*
Employer Name*
Emergency Contact Information
Emergency Contact #1*
Emergency Contact #1 Relationship to You*
Emergency Contact #1 Phone Number*
Emergency Contact #2*
Emergency Contact #2 Relationship to You*
Emergency Contact #2 Phone Number*
Education
What is your highest level of education?*
What year did you graduate or do you plan to graduate?*
What did you study?*
What school did you attend for your highest education?*
City and State for Highest Education*
Previous Employment
Name of Most Recent Employer*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Salary*
Do you have another employer to list?*

YesNo
Name of Employer #2*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Starting Date*

MonthDayYear
Ending Date*

MonthDayYear
Salary*
Do you have another employer to list?

YesNo
Name of Employer #3
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Starting Date

MonthDayYear
Ending Date

MonthDayYear
Salary
Coaching Stops
Most Recent Coaching Position
Head Coach's Name
School Name
Phone Number
Applicant's Coaching Role
What were your responsibilities?
Tenure
How long were you there?
Coaching Position #2
Head Coach's Name
School Name
Phone Number
Applicant's Coaching Role
What were your responsibilities?
Tenure
How long were you there?
Coaching Position #3
Head Coach's Name
School Name
Phone Number
Applicant's Coaching Role
What were your responsibilities?
Tenure
How long were you there?
References
List at three adults you have known for at least one year, who are not related to you or Five Star Life employees and have a definite knowledge of your character and ability to work with students.
Supervisor Reference Name

First NameLast Name
Supervisor Reference Phone Number*
Supervisor Reference Email*
example@example.com
Reference #1 Name*

First NameLast Name
Reference #1 Phone Number*
Reference #1 E-mail*
example@example.com
Relationship
Reference #2 Name*

First NameLast Name
Reference #2 Phone Number*
Reference #2 E-mail*
example@example.com
Relationship
Reference #3 Name*

First NameLast Name
Reference #3 Phone Number*
Reference #3 E-mail*
example@example.com
Additional Reference Name

First NameLast Name
Additional Reference Phone Number
Additional Reference E-mail
example@example.com
Relationship
Please select the area(s) of interest*

Adventure Sports (High Ropes & Rock Wall)ArcheryArts & CraftsBasketballBlacksmithingBoating & FishingEarly Learning CenterEducational ProgramsEquine & HorsemanshipEvent HostingFacility MaintenanceFundraisingGardening & BotanyGrant WritingGrounds CareHatchet ThrowingHealth OfficerHospitality TeamHuman ResourcesLake LifeguardNature ProgramsPhotographySnap ProgramSports & GamesSummer InternshipSummit CoachTeam-BuildingTransportationVideographyOther
What position are you applying for?*
Type of Employment Desired*

Full-TimePart-Time
What size T-shirt do you wear?*
Please list any experience you have working with kids*
Why do you want to be a volunteer for Five Star Life?*
Five Star Life Volunteers You Know
Please state why you are qualified for this position.*
What skills do you have that will benefit you in this position?*
If hired, can you provide proof you are eligible to work in the U.S.?*

YesNo
Do you have an active checking account (for payroll deposits)?*

YesNo
Integrity - who you are when no one is looking...the real you*

ExcellentGoodNeeds Improvement
Respect - treat others the way you want to be treated*

ExcellentGoodNeeds Improvement
Responsibility - taking ownership of your past choices, current reality and future dreams*

ExcellentGoodNeeds Improvement
Courage - the strength to do what is right over what is popular*

ExcellentGoodNeeds Improvement
Sacrifice - giving up something now for something greater later or giving up something you want in order to help someone else win*

ExcellentGoodNeeds Improvement
Initiative - the power or opportunity to act or take charge before others do*

ExcellentGoodNeeds Improvement
Commitment - devoted to a task or purpose*

ExcellentGoodNeeds Improvement
Communication - interchange of thoughts, opinions, or information by speech, writing, or signs*

ExcellentGoodNeeds Improvement
Coachable - willing to be pushed to be improved*

ExcellentGoodNeeds Improvement
Team Participation - thrives in various and diverse environments*

ExcellentGoodNeeds Improvement
Upload Resume *Job Application

Browse Files

Cancelof
Headshot

Browse Files
Please use a picture of just yourself. Cancelof
Personal History
Five Star Life/Summit

Disclosure Form - Five Star Life and Summit cares about the children and youth in our programs and desires to ensure their safety while they are in our supervision. Because we care for children and youth, our organizations join in asking any new staff member or volunteer who will be interacting with children and/or youth, to complete this disclosure form. Please complete the following questions by circling the appropriate response. Please attach an explanation for any "yes" answer.
1. Have you ever been treated for a psychiatric disorder?*
Please explain.*
2. Have you ever been arrested, convicted, or pleaded guilty to a crime?*
Please explain.*
3. Have you ever been accused, charged, or alleged to have, or have you ever committed any act of neglecting, abusing, or molesting any child?*
Please explain.*
4. Have you ever been concerned that you may have an addiction to drugs, alcohol, or pornography;or has anyone ever suggested that you may have a problem with any of the above?*
Please explain.*
5. Have you been convicted of the possession, use, or sale of drugs within the last seven years?*
Please explain.*
6. Have you been released from incarceration for a conviction of the possession, use, or sale of drugs within the last seven years?*
Please explain.*
7. Within the past 30 days have you abused alcohol, legal or illegal drugs?*
Please explain.*
8. Has your driver’s license been suspended or revoked within the last seven years?*
Please explain.*
9. Is there any fact, circumstance, or pattern involving your background that would make it inappropriate for you to serve with minors or would compromise the integrity of the Five Star?*
Please explain.*
10. Do you have a physical or mental limitation that would hinder you from being able to perform your job and/or duties? *
Please explain.*
List all previous work involving children (organization name, city, state, type of work)*
Health History
NOTE: All PARTICIPANTS must have an up-to-date signed Health History Form as well as Assumption of Risk, Liability Release, Indemnity Agreement, Picture and Video Waiver and Release to participate in any leadership experience at Summit.

PLEASE READ AND ANSWER THE QUESTIONS BELOW: This form is intended to remind leaders and participants of the seriousness of attempting adventure activities with an old preexisting injury, a heart condition, or other condition which might be aggravated by the event. Please connect with a Summit facilitator if you need to share any additional and pertinent information.
1. Any preexisting injuries (ankle, neck, back, knee, wrist, shoulder, etc.) that might be aggravated by participating?*

YesNo
Explain.
2. Taking any current medications?*

YesNo
Explain.
3. Any heart problems or medication?*

YesNo
Explain.
4. Do you have high blood pressure*

YesNo
Explain.
5. Do you have allergies (bees, insects, medications, etc.)?*

YesNo
Explain.
6. Do you have physical limitations?*

YesNo
Explain.
7. Do you have any special dietary needs?*

YesNo
Explain.
8. What is your current level of activity back at home?*

LowMediumHigh
9. Are you pregnant or believe you may be pregnant?*

YesNo
Please include any additional information that you feel is relevant.
Attach Resume

Browse Files

Cancelof
Liability Release
Signature*
Parent/Guardian Signature*
Thank you for applying with Five Star Life. Please complete our background check. You will be directed to this page after you submit your application.

** If you have already submitted a background check with Five Star Life, there is no need to fill out the next page. Thank you.
Please Select*
Should be Empty:

Basic Information

Emergency Contact Information

Education

Previous Employment

Coaching Stops

References

Personal History

Health History

Liability Release