Camp Nurse Volunteer Application

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Please answer the questions below.

Email *

Name *

Address (include city, state, and zip) *

Phone *

How did you hear about Camp Uskichitto? *

Criminal Record - Have you ever been convicted of a crime, other than a minor traffic offense? If yes, please describe (Note: a prior accusation or conviction is not an automatic rejection. The type of conviction or accusation and when it occurred will be evaluated by the camp before any decision is made)? *

Yes

If answered yes above, please explain.

What medical licenses/certifications do you possess currently? *

Do you have current BLS certification for adult, child, and infant? *

Yes

Hospital or clinic where you are currently or were most recently employed. *

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