Employment Application Form - 4-H Camp & Learning Centers at Tanglewood & Blueberry Cove - University of Maine Cooperative Extension

Personal Details

Name*

First Last

Nickname or preferred name

Pronouns

Date of birth*

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

College or School Attending if Applicable*

Have you ever attended a UMaine System college/program or worked for the University of Maine in the past?*

Yes
No

Working With Us

Which position(s) interests you the most?*

Specify other position*

Dates of availability*

For positions available at both locations, what is your preference?*

No preference
Tanglewood, Lincolnville
Blueberry Cove, Tenants Harbor

Education and Experience

Education history*

List all of the high schools and colleges you have attended or are currently attending. Please include college major (if applicable) and dates of graduation, or expected graduation.

Share about your experience (if any) in working with children?*

Please describe any experience you have working with children.

Employment/volunteer history*

List any related work or volunteer experience below. Include the position you held, name and address of the organization, and dates of employment.

References*

Please list three people we may contact for references. Include their email address, phone number, and relationship to you. Examples of good references might be employers, teachers, or coaches. References should not be related to you.

Certifications

Please list all certifications you hold and their expiration dates.

Note: If accepted for a position you will need to provide copies of all relevant certifications.

All About You

Why do you want to work at Tanglewood or Blueberry Cove?*

Did you attend camp or participate in an outdoor education program as a child?*

Yes
No

If yes, where and when? What did you enjoy most about the experience?

Which age group do you prefer to work with (select all that apply)?*

5-6
6-7
8-10
11-13
14-17

List your reason(s) for your choice(s) above.*

What do you hope young people will gain from educational outdoor experiences?*

What personal interests, skills, knowledge, or aspects of your character would make you a good member of our staff team?*

What do you think makes a good youth mentor and what qualities do you possess that will help you be one?*

What do you think will be the greatest challenge for you in this position?*

Please describe one or more of your most memorable outdoor experiences.*

The activities offered at our sites are mostly based on the passions and interests of our staff. What kinds of activities would you be most excited to lead or co-lead and what experiences do you have with those activities?*

Please feel free to add any additional information that might help us understand more about you and your qualifications.

How did you hear about this job?*

Disclosure

Have you ever been convicted of any crime other than a minor traffic violation?*

Yes
No

If yes, please explain*

A conviction will not necessarily bar you from employment. The time, circumstance, seriousness, and nature of the violation and rehabilitation will be taken into consideration.

Is there anything that would interfere with your ability to perform the job-related functions for the job which you have applied?*

Yes
No

If there is, please explain*

If you are offered a position at Tanglewood and Blueberry Cove, we will conduct a criminal background check.
Alcohol, drugs, and tobacco products are prohibited on campus, even if the employee is of the legal age to partake in these substances.

Statement of Purpose

Statement of Purpose*

Statement of Purpose I certify that my application and all attachments are true and complete to the best of my knowledge. I understand that any incorrect, incomplete, or false statements or information furnished by me may, at the discretion of the Tanglewood/Blueberry Cove 4-H Camps, disqualify me from employment, or cause my dismissal. I hereby authorize Tanglewood/Blueberry Cove 4-H Camps to make a thorough investigation of my past employment and activities. I release from liability the University of Maine 4-H Camps and Learning Centers at Tanglewood and Blueberry Cove, 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.

Agree

Certificate of Applicant*

CERTIFICATE OF APPLICANT I certify that all answers and statements contained in this application are true to the best of my knowledge and belief. I understand that any false or misleading information may subject me to DISQUALIFICATION before the appointment or DISMISSAL after the appointment. I also understand that employment is contingent upon my providing proof of certifications as well as identity and the right to work and may be contingent upon the successful completion of a pre-employment medical examination, drug test, and background checks and that full-time regular employees are required to participate in certain insurance and retirement programs.

Agree

Date*

Signature via typing legal name

Phone

This field is for validation purposes and should be left unchanged.