Medomak Staff Application-2020
Email address *
Contact Information
Last Name *
First Name *
Social Security Number (111-22-333) *
Permanent Address *
Permanent Address City *
Permanent Address State *
Permanent Address Zip Code *
Phone Number *
Fax Number
E-Mail address *
School or Business Name
School or Business Address
School or Business City
School or Business State
School or Business Zip Code
School or Business Phone Number
School or Business E-Mail
General Information
Start Date Available ASAP *
End Date Available *
What type of position do you want at camp? *
What is your desired salary? *
Do you meet or exceed any minimum age requirements for that position? *
Can you perform the essential functions of the job for which you have applied, with or without reasonable accommodation? *
If you are hired would you desire or need housing for any person(s) other than yourself at the camp? *
Past Work History
Provide a full record of all employment — paid and volunteer — and explain any gaps in employment. Include any positions on camp staff. Use provided extra space , if necessary.

Please use format below:

Date Employed, Employer Name, Address & Phone Number, Nature of work, Reason for Leaving
Past Work History #1
Past Work History #2
Past Work History #3
Past Work History #4
Past Work History #5
Please use the space below to add any additional information on your past work experiences
Indicate any employer you do not wish us to contact, and the reason
Give names and contact information of three persons [not relatives] having knowledge of your character, experience, work habits, and ability.

Use Format Below:
Reference Full Name, Relationship, Phone Number & E-mail
Reference #1 *
Reference #2 *
Reference #3 *
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