CDCNNJ - YES CAMP Employment Application

Applicant's Name*

First NameLast Name

Applicant's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Applicant's Phone Number*

Please enter a valid phone number.

Applicant's Email*

example@example.com

Position(s) applying for*

Lead TeacherCamp CounselorClub OT AMClub OT PM

List job related skills*

Achievements (training/special skills/language proficiency)*

Do you have any impairments, physical, mental,or medical, which would interfere with your ability to perform the job forwhich you have applied?*

YesNo

If Yes, please explain

Have you been convicted of a felony in the last seven (7) years?*

YesNo

I understand that such conviction may be relevant if job related, but does not bar you from employment.*

Yes

(Such conviction may be relevant if job related, but does not bar you from employment.) If yes, please explain

Please list activities or sports for which you would be capable and willing to direct, sponsor, or coach. *

Please attach copies of all your post secondary transcripts. Should you be offered a position, official copies of your transcripts must be provided to the school for inclusion in your personnel file*

List the last three (3) schools attended.*

	School	Years Completed	Degree Diploma	GPA Class Rank	Major	Minor
Entry #1
Entry #2
Entry #3

Sequentially list your teaching experience with most recent first. *

	School Name	Grades or Subjects	Dates
Entry #1
Entry #2
Entry #3

List medical certifications? What Level?

Medical Certification remains valid for how many years?

Do you have a state teaching certificate?*

YesNo

State teaching certificate in what state?

State teaching certificate remains valid for how many years?

What kind of state teaching certificate?

Give two references who are qualified to speak of your character. (Do not list family members or relatives.) *

	Full Name	Telephone	Years Known
Entry #1
Entry #2
Entry #3

Employer*

Phone Number*

Please enter a valid phone number.

Dates Employed (From - To)*

Summarize the nature of the work performed and job responsibilities: *

Job Title*

Hourly Rate/Salary*

Immediate Supervisor and Title*

Reason for Leaving *

May we contact for reference?*

YesNoLater

Employer

Phone Number

Please enter a valid phone number.

Dates Employed (From - To)

Summarize the nature of the work performed and job responsibilities:

Job Title

Hourly Rate/Salary

Immediate Supervisor and Title

Reason for Leaving

May we contact for reference?

YesNoLater

Employer

Phone Number

Please enter a valid phone number.

Dates Employed (From - To)

Summarize the nature of the work performed and job responsibilities:

Job Title

Hourly Rate/Salary

Immediate Supervisor and Title

Reason for Leaving

May we contact for reference?

YesNoLater

Have you ever worked under a different name for any of the employers you have listed? If so, what was the name or names?

Are you holding or have you already signed a contract for the summer with any other educational institution?*

YesNo

In what ways do you invest in your personal growth and development? *

I understand that YES Summer Camp does not discriminate in its employment practices against any person because of race, color, national or ethnic origin, gender, age, or qualified disability. I also understand that I am required to be in attendance each day the Camp is in session until the six-week program is complete.

I hereby certify that the facts outlined in this application process are true and complete to the best of my knowledge. I understand that falsification of any statement or a significant omission of fact may prevent me from being hired, or if hired, may subject me to immediate dismissal regardless of the time elapsed before discovery. If I am released under these circumstances, I further understand and agree that I will be paid and receive benefits only through the day of release.

I authorize YES Camp to thoroughly interview the primary references that I have listed, any secondary references mentioned through interviews with primary references, or other individuals who know me and have knowledge regarding my testimony and work record. I also authorize the camp to thoroughly investigate my work records and evaluations, my educational preparation, and other matters related to my suitability for the position. I authorize references and my former employers to disclose to the camp any employment records, performance reviews, letters, reports, and other information related to my life and employment, without giving me prior notice of such disclosure. In addition, I hereby release the camp, my former employers, references, and all other parties from all claims, demands, or liabilities arising out of or in any way related to such investigation or disclosure. I waive the right to ever personally view any references given to the camp.

Since I will be working with children, I understand and agree that any offer of employment that I may receive from the camp is conditioned upon the receipt of background information. The camp may refuse employment or terminate conditional employment if the camp deems any background information unfavorable or if it could reflect adversely on the camp or me as a role model. I understand that this is only an employment application and that no employment contract is being offered at this time.

I certify that I have carefully read and do understand the above statements.

Signature*

Date*

Date

The employer is an Equal Opportunity Employer. The employer does not discriminate in employment and no question on this application is used to limit or excuse any applicant's consideration for employment on a basis prohibited by local, state, or federal law.

YES Camp Employment Application

Applicant's Name and Address

Position Desired

Professional Qualifications

Personal References

Employment History #1

Employment History #2

Employment History #3

Background