4-H Memorial Camp

Summer Camp Employment Application

Last Name:

First Name:

Date of Birth:

Cell Phone:

Home Phone:

Email Address:

example@example.com

Do you check your email regularly?

YesNo

What is the best way to contact you?

Cell PhoneHome PhoneEmail

Current Address:

Home Address (if different from current):

Position of Interest (please select all that apply):

Program Staff area of interest:

Have you ever applied for employment with us before?

YesNo

If so, when?

Have you ever worked for 4-H Memorial Camp before?

YesNo

If so, when?

How did you hear about 4-H Memorial Camp?

Name of High School:

Graduation Date or Expected:

Date

Name of College/University, if applicable:

Graduation Date or Expected:

Date

College/University Course of Study:

Are you currently or have you ever been a member of a 4-H Club?

YesNo

If yes, how many years?

Which county?

Have you ever been a camper at 4-H Memorial Camp?

YesNo

If yes, which years?

Were you a C.I.T.?

YesNo

If yes, which years?

Do you have any of the following certifications? (check all that apply)

Please list all previous or current work experiences beginning with the most recent.

Previous Employer #1

Name of Employer/Organization:

Dates of Employment:

Position/Title:

Employer Address:

Employer Phone Number:

Previous Employer #2

Name of Employer/Organization:

Dates of Employment:

Position/Title:

Employer Address:

Employer Phone Number:

Previous Employer #3

Name of Employer/Organization:

Dates of Employment:

Position/Title:

Employer Address:

Employer Phone Number:

Previous Employer #4

Name of Employer/Organization:

Dates of Employment:

Position/Title:

Employer Address:

Employer Phone Number:

Why are you interested in a position at 4-H Memorial Camp?

What are your leisure time hobbies/interests?

What do you think the main responsibilities of a camp staff member/counselor are?

What do you consider to be your main strengths and qualifications relevant to a position at summer camp?

Selecting camp counselors/staff member is a highly competitive process. What makes you stand out?

List any leadership roles, personal attributes, affiliation with other clubs or organization (i.e. Scouts, YMCA, etc.) or relevant coursework, workshops, or work experience you have that relates to camp work.

Would you be interested in obtaining a Lifeguard Certification to assist or lead the Waterfront Program Area?

YesNo

How do you hope that working at 4-H Memorial Camp will benefit you in your future?

Camp Counselor requirements include the ability to be available for the majority of the 4-H Youth Camp weeks. Please select all the camp weeks that you are available to work. Priority is given to applicants who are available for training and all weeks of camp.

Program Staff requirements include all the weeks listed above as well as the weeks in between, before, and after. Program Staff should be onsite from mid-May to mid-August. Are you available to work these dates?

YesNo

If no, which dates are you available to work?

Please provide information for three references that we can contact. These people should have knowledge of your personality, work habits, and character. Teachers, principals, guidance counselors, former employers, etc. are some examples of references. No family members are allowed.

Reference #1

Name:

Address:

Phone Number:

Email Address:

example@example.com

How does this person know you?

Reference #2

Name:

Address:

Phone Number:

Email Address:

example@example.com

How does this person know you?

Reference #3

Name:

Address:

Phone Number:

Email Address:

example@example.com

How does this person know you?

*Please note the references listed above, must complete the Employee Reference Form. This form can be filled out digitally OR a paper copy can be submitted; references do NOT need to complete both versions of the form.

Your application will not be considered complete and will not be reviewed until all three reference forms/submissions have been completed.

A paper copy can be printed from the 4-H Memorial Camp website and the link to the digital version can also be found there. Here is the direct link to both versions of the reference form:

https://4h.extension.illinois.edu/events/4-h-memorial-camp/employment-opportunities

All paper forms must be sealed and submitted in the mail to the attention of:

4-H Memorial Camp

499 Old Timber Road

Monticello, IL 61856

If you have any questions, you may contact:

Andy Davis, Camp Director

ardavis1@illinois.edu

Niki Hoesman, Assistant Camp Director

hoesman2@illinois.edu

Illinois is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as a qualified individual with a disability, or criminal conviction history. Illinois welcomes individuals with diverse backgrounds, experiences, and ideas who embrace and value diversity and inclusivity. (www.inclusiveillinois.illinois.edu)

4-H Memorial Camp

Summer Camp Employment Application

Education

4-H Involvement/Certifications

Work Experience

Please list all previous or current work experiences beginning with the most recent.

Previous Employer #1

Previous Employer #2

Previous Employer #3

Previous Employer #4

Extended Responses

References

Reference #1

Reference #2

Reference #3