Summer Programs Staff Application Form 2025

Summer Programs Staff Application Form 2025

Family Week Programs
We are seeking summer counselors from the States of Michigan, Illinois, Ohio, Indiana, and Wisconsin. Come meet new friends, make new memories and make a difference in the lives of young Deaf and Hard of Hearing children.

Before you apply, please make sure you meet all of the following criteria:
- Will you be available to work June 26-29, June 29-July 4, July 6-11, July 13-18, and July 20-25, 2025?
- Are you Deaf, Hard of Hearing, CODA, or an aspiring American Language Interpreter/Deaf Education teacher?
- Are you fluent in American Sign Language? Being fluent means you can carry on ASL conservation.
Name:*

First NameMiddle InitialLast Name
Are you DDBHH/CODA/Hearing?*

DeafHard of HearingCODAHearing
Application Status:*

New ApplicantReturning Staff Member
If returning, when was your last summer programs date you participated in as a staff?
If you are a returning staff member, which of the role did you have as a staff?

Counselor in TrainingCounselorArt TeacherDrama TeacherChefLifeguardBoat Driver

List three positions you are interested in.*

What is your e-mail address?*
example@example.com
What is your phone number?*
What is your cell phone number?*
Please enter a valid phone number.
Current Address is Valid Until:*

MonthDayYear
Date
What is your permanent address?*

Street Address

Street Address Line 2

CityState / Province / Region

Postal / Zip CodeCountry
What is your current address?*

Street Address

Street Address Line 2

CityState / Province / Region

Postal / Zip CodeCountry
Present Occupation or Year in School:*
Where did you hear about the positions available for our summer programs?

Search Engines (Google, Yahoo, etcs)Social Media (Facebook, Instagram, Tik Tok, etcs)Recommended by friend or colleagueOther

Education & Background Information
High School information - NAME:
Name
City:
City
State:
State
Please list any community college, university, or tech school you have attended:
Name
City:
State:
Major/ Area of Study:
Start Date

MonthDayYear
Date
Highest Grade Completed:
Degree or Credits:
Please list any community college, university, or tech school you have attended:
Name
City:
State:
Major/ Area of Study:
Start Date

MonthDayYear
Date
Highest Grade Completed:
Degree or Credits:
Do you have the legal right to work in the United States of America?*

YesNo
Do you hold a current US Driver’s License?*

YesNo

Areas of Interest & Personal Statement:
Please write 3-4 sentences about yourself. Things you like, where you are from, where you go/or went to school, any fun facts, hobbies, or anything else you would like to share.*
Briefly describe your experience in working with children in school, the summer programs, school programs, and/or camp. It can be positive or negative but share what you learned from it.*
What qualities or characteristics do you possess that would be needed to make a great family week staff member?*
Upload a photo of yourself *

Cancelof
Do you hold any special certifications or licensure? If so, please list each one with issuing authority and expiration dates (Example: Red Cross First Aid/CPR/AED certification, Lifeguard Certification)*
Upload any current certifications

Cancelof
Upload your Resume.*

Cancelof

Employment History:
EMPLOYMENT HISTORY - Employer's Name:
Address:
Phone Number:
Position/Title:
Dates Employed:
Major Responsibilities:
Reason for Leaving:
Supervisor's Name:
Employer's Name:
Address:
Phone Number:
Position/Title:
Dates Employed:
Major Responsibilities:
Reason for Leaving:
Supervisor's Name:
Employer's Name:
Address:
Phone Number:
Position/Title:
Dates Employed:
Major Responsibilities:
Reason for Leaving:
Supervisor's Name:
EXPERIENCE AS A CAMPER/STAFF MEMBER - Camp Name & Location:
Organization:
Position:
Years
Supervisor:
EXPERIENCE AS A PARTICIPANT/STAFF MEMBER - Summer Programs/Camp Name & Location:
Organization:
Position:
Years
Supervisor:

References:
REFERENCES: List three (3) persons NOT related to you who can judge your qualifications for this position. If you do have previous experience as a camp staff member, one reference should be from a camp director or camp administrator would be helpful (not required).
Reference Name:*
Reference Phone Number:*
Reference E-mail:*
example@example.com
Reference Position Title:*
How long have you known this reference?*
What is your relationship with this person?*
Reference Name*
Reference Phone Number:*
Reference E-mail:*
example@example.com
Reference Position Title:*
How long have you known this reference?*
What is your relationship with this person?*
Reference Name*
Reference Phone Number:*
Reference E-mail:*
example@example.com
Reference Position Title:*
How long have you known this reference?*
What is your relationship with this person?*

Submission:
I understand that a successful completion of a physical examination and current immunizations are conditions of employment.*

YesNo
I understand that employment is contingent upon passing a criminal background check and drug test and I give Holley Family Village permission to conduct a check if necessary.*

YesNo
I certify that all information provided is true and complete. I understand that falsification or significant omission of any information may be considered justifications for dismissal if discovered at a later date.*

YesNo
Signature

Clear
Use the mouse to draw your signature.
Date*

MonthDayYear
Date
The Holley Institute's Carls Family Village is an Equal Opportunity Employer. The Council does not discriminate on the basis of race, color, sex, age, disability, pregnance, national origin, citizenship or sexual orientation.
Should be Empty:

Education & Background Information