Returning Staff Application

Personal Details

Name(Required)

First Middle Last

Nickname or Preferred Name

Date of Birth

Email(Required)

Phone Number(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you possess a drivers license?

From which state?

Are you currently enrolled as a student? (College or High School)

What are your dates of availability(Required)

Education & Experience

Education(Required)

High School/College/Other

School Name

Completed (Yes or No)

Certifications (Lifeguard, First Aid, WFA ect.)

Certification

Expiration Date

If you return to camp this summer would you be interested in either Lifeguard or Trip Leader Training?

Disclosures

Have you ever been convicted of a criminal offense?

Yes

- If you're offered a position at Bryant Pond or Greenland Point 4-H Camp, we will need your signature authorizing a criminal background check.
- Camp policy requires all staff to hold Adult and Child First Aid and CPR certifications. Training is provided
- Alcohol, tobacco and tobacco product use are forbidden on campus, even if the employee is of the legal age to partake in these substances. Tobacco use is limited to personal time. off-campus, and not in the view of students.
- Alcohol is not allowed on campus.

Statement of Purpose:
I certify that my application and all attachments are true and complete the best of my knowledge. I understand that any incorrect, incomplete, or false statements or information furnished by me may, at the discretion of Bryant Pond/Greenland Point 4-H Camp to make a thorough investigation of my past employment and activities. I release from liability Bryant Pond/Greenland Point 4-H Camps, former employers, or any persons supplying such information. The language in this application is not intended to create, nor is it to be misconstrued to constitute, a contract of employment.

I agree to the above statements.