2020 Milky Way Farm Summer Day Camp Staff Application
Name:
*
First Name
Middle Initial
Last Name
Rank two positions you are interested in.
Position
Choice #1
Little Farmer - ages 4-6
Farm Fun 1,2,3 - ages 7-11
Choice #2
Little Farmer - ages 4-6
Farm Fun 1,2,3 - ages 7-11
What dates (from start to end) are you available for this summer?
*
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Month
-
Day
Year
Date Picker Icon
*
-
Month
-
Day
Year
Date Picker Icon
What is the BEST email address for you to be reached?
*
What is the BEST phone number for you to be reached?
*
-
Area Code
Phone Number
What is your current address?
*
Street Address
Street Address Line 2
City
State / Province / Region
Postal / Zip Code
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
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Gibraltar
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Guadeloupe
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Iraq
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Italy
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Japan
Jersey
Jordan
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Kenya
Kiribati
North Korea
South Korea
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Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Present Year in School:
*
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Next
New Camp Staff Application - Page 2
Please list your High School information:
Name
High School Location
City
Please list any college or university you have attended:
Name
If in college, what is your current major?
Sports/Activities/Scholastic Honors?
Do you have the legal right to work in the United States of America?
*
Yes
No
Do you hold a current US Driver’s License?
*
Yes
No
Do you know of any reason why you would not be able to perform the essential functions of the job position’s for which you are applying with or without reasonable accommodation?
*
Yes
No
Have you ever been convicted of a crime (other than a traffic violation)?
*
Yes
No
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New Camp Staff Application - Page 3
Why are you interested in working at a summer camp?
*
Briefly describe how you think you could contribute to the success of our camp program.
*
List your experience working with children, your role.
*
List any of your certifications that will be current through August 2021:
OTHER RELATED TRAINING OR SKILLS (please indicate expiration date mm/dd/yyyy)
Working at a summer camp is difficult at times. Your duties will include working with farm animals, putting camper’s needs first, and cleaning parts of camp. How do feel about these things and why would you be good working in this kind of an environment?
*
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New Camp Staff Application - Page 4
Employment History
Employer's Name
Address
Address
-
Area Code
Phone Number
Position
Position
Dates Employed
Dates Employed
Major Responsibilities
Major Responsibilities
Reason for Leaving
Reason for Leaving
Supervisor's Name
Supervisor's Name
Experience as a Camper or Camp Staff Member:
Camp Name & Location
Organization
Organization
Years
Years
Supervisor Name
Supervisor
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New Camp Staff Application - Page 5
REFERENCES: List three (3) persons NOT related to you who can judge your qualifications for this position. If you have previous experience as a camp staff member, one reference should be from a camp director or camp administrator.
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Full Name
Reference Phone Number:
*
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Area Code
Phone Number
Reference E-mail:
*
Reference Position Title:
*
How long have you known this reference?
*
In what way do you know this person? (This person should not be related to you.)
*
Reference Name
*
Reference Phone Number:
*
-
Area Code
Phone Number
Reference E-mail:
*
Reference Position Title:
*
How long have you known this reference?
*
In what way do you know this person? (This person should not be related to you.)
*
Reference Name
*
Reference Phone Number:
*
-
Area Code
Phone Number
Reference E-mail:
*
Reference Position Title:
*
How long have you known this reference?
*
In what way do you know this person? (This person should not be related to you.)
*
I understand that employment is contingent on Report of criminal history from the Pennsylvania State Police (PSP); Child Abuse History Clearance from the Department of Human Services (Child Abuse); and Fingerprint based federal criminal history submitted through the Pennsylvania State Police or its authorized agent (FBI).
*
Yes
No
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.
*
Yes
No
Submit Application
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