Returning Staff Application
for Elks Camp Grassick
Identifying Information
For applicants who have been employed at Camp Grassick in previous years and are applying for positions working directly with campers.
Name
*
First Name
Middle Name or Middle Initial
Last Name
Gender
*
Nickname or Preferred Name
T-Shirt Size
*
Social Security Number
Can be supplied after hire if preferred.
Date of Birth
*
-
Month
-
Day
Year
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Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Permanent Address if different from above
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Telephone Number(s)
*
Email
*
Name of Parent(s) or Nearest Relative
*
Emergency Contact Name
*
Relationship to Applicant
*
City and State of Emergency Contact
*
Emergency Contact Phone Numbers
*
What position are you applying for? (Check more than one if interested.) (*Requires degree, certification, or specific education requirements.)
*
Counselor
Recreation Staff
Craft Instructor
Lifeguard/Waterfront*
Reading Instructor*
Speech/Language Instructor/Therapist*
Occupational Therapist/Instructor*
Occupational Therapy Supervisor*
Speech Therapy Supervisor*
Nurse*
Other
Education
High School Name and Location
*
College/University Name and Location
*
Major
*
Minor
Degree(s) Earned
Please list any extracurricular or volunteer activities you are involved in.
*
Type a question
*
Non-Swimmer
Average Swimmer
Advanced Swimmer
Lifeguard Training
WSI Training
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Skills and Qualifications
What are 3 things that you think you did well at Camp Grassick in your previous summer?
*
What are 3 areas where you think you could improve in your work at Camp Grassick?
*
What is something that you learned in your summer(s) at Camp Grassick?
*
What are two goals that you have for this summer?
*
Is there anything else that you would like to add?
Signing this document gives permission for Elks Camp Grassick to contact references and perform a criminal background check.
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