2023 Summer Camp Volunteer Nurse Application
Overview
Full Name
*
First Name
Middle Name
Last Name
Current Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email Address
*
example@example.com
Session Choice
Day Camp 1: July 24th – 28th
Day Camp 2: August 21st – 25th
Day Camp 3: August 28th – September 1st
Overnight Mini Camp 1: July 19th – July 21st
Overnight Mini Camp 2: July 31st – August 2nd
Overnight Mini Camp 3: August 9th – August 11th
Overnight Traditional Resident Camp: August 14th – 18th
Current Status (Check all that Apply)
*
Employed Full TIme
Employed Part Time
Full Time Student
Part Time Student
Unemployed
Retired
Highest level of education attained?
Degree
If in School, Name of Institution
School Name
If in School, Current Status
Freshman, Sophomore, Junior, Senior, Graduate School
If in School, Course of Study
Course of Study
How many years of nursing work do you have?
0-1 year
1-2 years
2-3 years
Over 3 years
Are you at least 25 years old?
Yes
No
Work History
Enter your most recent work history beginning with most current
1.) Place of Employment
*
Location
*
City, State
Position Title
*
Dates of Employment
*
MO/YEAR - MO/YEAR
Supervisor Name and Title
*
Full Name, Title
Supervisor Phone Number
*
Supervisor Email
*
OK to contact supervisor?
*
Yes
No
Reason for Leaving
*
Still Employed
Resigned
Terminated
Got a new job
Started school
2.) Place of Employment
*
Location
*
City, State
Position Title
*
Dates of Employment
*
MO/YEAR - MO/YEAR
Supervisor Name and Title
*
Full Name, Title
Supervisor Phone Number
*
Supervisor Email
*
OK to contact supervisor?
*
Yes
No
Reason for Leaving
*
Still Employed
Resigned
Terminated
Got a new job
Started school
3.) Place of Employment
Location
City, State
Position Title
Dates of Employment
MO/YEAR - MO/YEAR
Supervisor Name and Title
Full Name, Title
Supervisor Phone Number
Supervisor Email
OK to contact supervisor?
Yes
No
Reason for Leaving
Still Employed
Resigned
Terminated
Got a new job
Started school
Certifications
Are you a certified RN?
*
Yes
No
If other, please explain.
Have you ever been convicted of a felony?
Yes
No
Self Assessment
Understanding Expectations: Honesty will help you to be more successful in a camp environment. Should you be hired, we will revisit your answers to these questions during evaluation periods.
Positive, open communication; avoiding gossip, and seeking understanding are essential components to a successful workspace. Rate yourself on the ability to have open conversations and seek compromise.
1
2
3
4
5
6
7
8
9
10
Difficult
Easy
1 is Difficult , 10 is Easy
Keeping a positive, adaptable, and collaborative attitude is required for success in a work environment. Rate your ability to stay positive and helpful.
1
2
3
4
5
6
7
8
9
10
Difficult
Easy
1 is Difficult , 10 is Easy
Policies
Overnight stays in the Health Center in a small private bedroom are REQUIRED during Mini Camp and Resident Camp sessions.
Initial your understanding
Will you submit to an enhanced, nationwide FBI Background Check? (required)
*
Yes
No
Camp Wilani is a smoke, drug, alcohol, and vape-free environment. Engagement in such activities at camp may result in immediate termination of employment.Type your initials to acknowledge your understanding of this policy.
*
Initial your understanding
References
Professional references are people who have supervised you or overseen your work. They are: employers (preferred), teachers, professors, coaches, guidance counselor, pastors or other spiritual leaders, mentors, social service workers, or other similar person. They are NOT: family members, romantic partners, people you supervise, co-workers with the same title or job duties as you, or friends.
Reference 1 Full Name
*
First Last
Reference 1 Job Title
*
Job Title
Reference 1 Place of Employment
*
Place of Employment
Relationship to you
*
Supervisor
Teacher/Professor
Guidance Counselor
Coach
Guidance Counselor
Reference 1 Years Known
*
Total years this person has known you
Reference 1 Email Address
*
Reference 1 Phone Number
*
Reference 1 Alternate Phone Number
Reference 2 Full Name
*
First Last
Reference 2 Job Title
*
Job Title
Reference 2 Place of Employment
*
Place of Employment
Relationship to you
*
Supervisor
Teacher/Professor
Guidance Counselor
Coach
Guidance Counselor
Reference 2 Years Known
*
Total years this person has known you
Reference 2 Email Address
*
Reference 2 Phone Number
*
Reference 2 Alternate Phone Number
Reference 3 Full Name
*
First Last
Reference 3 Job Title
*
Job Title
Reference 3 Place of Employment
*
Place of Employment
Relationship to you
*
Supervisor
Teacher/Professor
Guidance Counselor
Coach
Guidance Counselor
Reference 3 Years Known
*
Total years this person has known you
Reference 3 Email Address
*
Reference 3 Phone Number
*
Reference 3 Alternate Phone Number
Uploads
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By signing below, I hereby attest that the information contained in this application is true and accurate under penalty of law.
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