Name*:
Address:
City:	State: Zip:
Telephone*:
College Address: (if you live at school)
City:	State: Zip:
Telephone:
Year in School Sept. 2009	...Please choose... 11th Grade 12th Grade College Freshman College Sophomore College Junior College Senior Grad Student Teacher Adult
E-Mail Address*:
Cell Phone Number:

Educational Background

	Dates Attended	School	Major	Degree
High School
College
Other

Past Employment (LIST THREE MOST RECENT JOBS)

Dates of Employment	Company Name	Address/Phone	Responsibilities	Supervisor	Reason for Leaving

Camp Experience (as Camper or Staff)

Dates Attended	Camp Name	Address	Camper or Staff Position	Supervisor	Reason for Leaving

References 3 persons (not personal friends or relatives) having knowledge of your character, experience and ability.

Name	Address	Phone	Email	Relationship

 

How did you hear about Black Bear Lake?
What type of position do you want at camp?
The camp season is from June 29 to August 21, 2009. Are you available to work the entire 8 weeks?	Yes No
If no, explain:
List any sport teams played (including any varsity letters received)
Do you sing? Do you play an instrument (which one)? Have you ever been in any theater productions?
List any experience working with children in schools, clubs, volunteer work, baby-sitting, etc.
Do you hold any current certification, training, or experience in the following areas? (List date certified)	CPR   First Aid Lifeguard   WSI

In the following list, put numeral "1" before those activities you can organize and teach as an expert or a "2" for those activities in which you can assist in teaching.

SPORTS	PERFORMING ARTS	FINE & APPLIED ARTS	LAKEFRONT & AQUATICS
Baseball/Softball Soccer Basketball Gymnastics In-Line Skating Archery Horseback Riding Martial Arts Volleyball Roller/Street Hockey Lacrosse Tennis Field Hockey Cheerleading Golf Camping/Outdoor Living Skills Ropes Course Leader Rock Wall Climbing	Acting Costume Design Stage Make-Up Set & Prop Design Puppetry Clowning Magic Hip Hop Dance Ballet Jazz / Tap Guitar Drums Piano Singing	Ceramics Painting Crafts Animation/Cartooning Jewelry Making Digital Photography Computers Rocketry Cooking Woodworking Radio Station Website/Graphic Design Model Making Science Fun	Canoeing Rowing Kayaking Sailing Jet Skiing Fishing Swim Team Lifeguarding Swim Instruction Water Polo

 

Additional questions or comments

 

I authorize investigation of all statements herein and release and all others from liability in connection with the same. I also authorize BBL to conduct necessary background checks, including criminal investigations to determine my fitness for the position applied for. I understand that, if employed, I will be an at-will employee and that any agreement to the contrary must be in writing and signed by the director of the camp. I also understand that untrue, misleading, or omitted information herein may result in dismissal, regardless of the time of discovery by the camp. In addition, I have never been the subject of an investigation relating to the physical or sexual abuse of another person. Yes   No

ELECTRONIC SIGNATURE* (Please type name)
DATE (Please type name)
All statements become part of any future employee personnel files. State Human Rights Law forbids discrimination on account of race, color, creed, sex, national origin or age.