Staff Application

First Name:  Middle Name:  Last Name:

E-mail address: Cell Phone#:

Date of Birth (mm/dd/yy):

PRESENT or SCHOOL ADDRESS:

Street:

City:   State:   Zip:

Phone:   Dates you expect to be at this address and phone (mm/dd/yy):

PERMANENT ADDRESS:

Position(s) Applying For:

Available to work:       From: (mm/dd/yy): To: (mm/dd/yy):

Spring Break Dates:   From: (mm/dd/yy): To: (mm/dd/yy):

How did you learn about Gyynn Valley?
Please check one of the following.

 Alumni   Years:

 Friend   Friend's Name:

 Internet   Website:

 Staff Fair   Where:

Other:

1. Name of College/University:

   Major: Year Please Select Freshman Sophmore Junior Senior

   Degrees Granted/Year:

2. Name of College/University:

   Major: Year Please Select Freshman Sophmore Junior Senior

   Degrees Granted/Year:

3. Name of College/University:

   Major: Year Please Select Freshman Sophmore Junior Senior

   Degrees Granted/Year:

List all information for the last four summers/years.

1. Name of Employer/Immediate Supervisor:

   From: (mm/dd/yy): To: (mm/dd/yy):

   Address: Phone:

   Nature of Work:

   Reason for Leaving:

2. Name of Employer/Immediate Supervisor:

   From: (mm/dd/yy): To: (mm/dd/yy):

   Address: Phone:

   Nature of Work:

   Reason for Leaving:

3. Name of Employer/Immediate Supervisor:

   From: (mm/dd/yy): To: (mm/dd/yy):

   Address: Phone:

   Nature of Work:

   Reason for Leaving:

4. Name of Employer/Immediate Supervisor:

   From: (mm/dd/yy): To: (mm/dd/yy):

   Address: Phone:

   Nature of Work:

   Reason for Leaving:

1. Camp: Director Name: Location:

   Position Please Select Camper Staff From: (mm/dd/yy): To: (mm/dd/yy):

2. Camp: Director Name: Location:

   Position Please Select Camper Staff From: (mm/dd/yy): To: (mm/dd/yy):

3. Camp: Director Name: Location:

   Position Please Select Camper Staff From: (mm/dd/yy): To: (mm/dd/yy):

Give names and contact information of 3 persons, or places of employment, who have knowledge of your character, experience and abilities (please do not list relatives or friends). After completing this application, you will be prompted to print out reference forms. Please ask your references to complete the forms and mail to Gwynn Valley Camp.

1. Name: Relationship to you:

   Address: City:

   State: Zip Code: Phone Number:

2. Name: Relationship to you:

   Address: City:

   State: Zip Code: Phone Number:

3. Name: Relationship to you:

   Address: City:

   State: Zip Code: Phone Number:

The following questions are designed to help us get to know you better and give you a chance to understand more of what your role in camp might be. They are very important and a mandatory part of the application process.

Autobiographical essay - tell us about yourself (family, education, social, etc.) and any other experiences which make you an excellent candidate for this position.

Why are you interested in working at a camp? Why Gwynn Valley specifically?

Describe all experiences you have had with children (including their ages and your responsibilities).

Please describe all leadership positions you have held and the related responsibilities.

What do you see being your greatest challenges with the lifestyle at camp? How will you manage these?

We are a non-sectarian camp - our campers and staff are of many faiths. We sing blessings at each meal and hold a service on Sundays. Would you be comfortable in this setting? If not, please explain why?

If you are interested in working with our older campers (ages 11-12 and ages 13-14) please explain why. Include your experience with that age group and your outdoor skills.

If you are interested in working in our Day Camp program, please explain why and list any personal experience you have had with other day camps.

If you are interested in working with our support staff (kitchen, maintenance, housekeeping, laundry, medical, office, etc) please describe your experience and explain why you are interested in doing this job in a camp setting.

Current Basic First Aid and CPR are required for employment. Copies of certifications must be turned in or mailed to the office before you begin work.

CPR Expires: (mm/dd/yy):

WFR Expires: (mm/dd/yy):

WFA Expires: (mm/dd/yy):

First Aid Expires: (mm/dd/yy):

Lifeguard Expires: (mm/dd/yy):

Swim Instructor Expires: (mm/dd/yy):

Archery Instructor Expires: (mm/dd/yy):

Canoeing Instructor Expires: (mm/dd/yy):

Kayaking Instructor Expires: (mm/dd/yy):

AMGA Expires: (mm/dd/yy):

Other

Please provide an explanation if you answer yes to any of the following questions.

Yes No Have you ever been accused, arrested or convicted of a misdemeanor or felony?

Yes No Have you ever been accused, arrested or convicted of any child related offenses?

Yes No Have you ever been addicted to or treated for alcohol or chemical dependence?

Explanation

Check the areas you feel qualified to instruct:

Please describe in detail your experience, qualifications, and aptitude for your top three skill areas.

I have answered all questions honestly and accurately and I have no problem complying with the type of lifestyle indicated by camp and camp policies. I also gives permission for the camp to check employment history, references, criminal records, and driving records. In the event of employment, I agree to abide by all operating procedures and policies and to be in compliance with Gwynn Valley's Drug/Tobacco/Alcohol-Free Workplace Policy.

PROTECTIVE SERVICES/CRIMINAL RECORD/MOTOR VEHICLE CHECK/CREDIT HISTORY REPORT for Gwynn Valley Camp, 1080 Island Ford Road, Brevard, NC 28712

I understand that Gwynn Valley Camp has a practice of requesting a background check which could include protective services/criminal record check/motor vehicle check/credit history report on prospective employees prior to contract confirmation. I hereby authorize Gwynn Valley's Insurance Carrier to conduct a Motor Vehicle Records check and release that information to Gwynn Valley Camp.

Other names records may be filed under:

Please list location of residences for the past 5 years (school and home counties):

City: State: Zip:

County: Area Code:

City: State: Zip:

County: Area Code:

City: State: Zip:

County: Area Code:

City: State: Zip:

County: Area Code:

City: State: Zip:

County: Area Code:

Applicant Signature: Date: (mm/dd/yy):