Employment Application

Personal Data

Date of Application *

YYYY

Last Name *

Your answer

First Name *

Your answer

Middle Initial

Your answer

Address *

Your answer

City *

Your answer

State *

Your answer

Zip *

Your answer

Phone *

Your answer

E-Mail Address

Your answer

Sex *

Male

Female

Required

Date of Birth *

YYYY

High School Diploma/GED

Yes

Post Secondary Degree

In Progress

Associates

Bachelors

Masters

Other:

Major

Your answer

Minor

Your answer

How did you hear about Camp Evergreen?

Your answer

Position/s you're interested in: *

Counselor (summer camp)

Counselor (day program)

Counselor (after school)

Night Supervisor (summer and/or weekends)

Support Staff (kitchen, maintenance, etc.)

Required

Work Experience

List most recent work experience first.

Company Name

Your answer

Immediate Supervisor

Your answer

Phone

Your answer

Job Title

Your answer

Job Description

Your answer

Dates: From month/year - To month/year)

Your answer

Reason for Leaving

Your answer

Company Name

Your answer

Immediate Supervisor

Your answer

Phone

Your answer

Job Title

Your answer

Job Description

Your answer

Dates: From month/year - To month/year)

Your answer

Reason for Leaving

Your answer

Company Name

Your answer

Immediate Supervisor

Your answer

Phone

Your answer

Job Title

Your answer

Job Description

Your answer

Dates: From month/year - To month/year)

Your answer

Reason for Leaving

Your answer

Would you like to be informed before we contact your current and/or previous employer?

Yes

Volunteer Work

Your answer

Licenses, Certifications, special skills, etc.

Your answer

Personal References

Preferably persons who know about your work/volunteer history.

Name *

Your answer

Phone Number *

Your answer

Name *

Your answer

Phone Number *

Your answer

Name *

Your answer

Phone Number *

Your answer

Have you ever been convicted of a crime, including sex related or child abuse offenses? *

Yes

Required

Signature

With my signature below (typed or written), I certify that all of the information on this and all attached pages is true, correct, and complete to the best of my knowledge and contains no willful falsifications or misrepresentations. I authorize all former employers to release job-related information they may have on file regarding my employment with them and I release all persons or companies from any liability or responsibility for providing such information.

Name *

Your answer

Date *

Your answer

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