2021 Milky Way Farm Summer Day Camp Staff Application

2020 Milky Way Farm Summer Day Camp Staff Application
Name: *

First Name Middle Initial Last Name

Rank two positions you are interested in.

	Position
Choice #1
Choice #2

What dates (from start to end) are you available for this summer? *

Month Day Year
*

Month Day Year
What is the BEST email address for you to be reached? *
What is the BEST phone number for you to be reached? *

Area Code Phone Number
What is your current address? *

Street Address

Street Address Line 2

City State / Province / Region

Postal / Zip Code Country
Present Year in School: *

New Camp Staff Application - Page 2
Please list your High School information:
Name
High School Location
City
Please list any college or university you have attended:
Name
If in college, what is your current major?
Sports/Activities/Scholastic Honors?
Do you have the legal right to work in the United States of America? *

Yes No
Do you hold a current US Driver’s License? *

Yes No
Do you know of any reason why you would not be able to perform the essential functions of the job position’s for which you are applying with or without reasonable accommodation? *

Yes No
Have you ever been convicted of a crime (other than a traffic violation)? *

Yes No

New Camp Staff Application - Page 3
Why are you interested in working at a summer camp? *
Briefly describe how you think you could contribute to the success of our camp program. *
List your experience working with children, your role. *
List any of your certifications that will be current through August 2021:
OTHER RELATED TRAINING OR SKILLS (please indicate expiration date mm/dd/yyyy)
Working at a summer camp is difficult at times. Your duties will include working with farm animals, putting camper’s needs first, and cleaning parts of camp. How do feel about these things and why would you be good working in this kind of an environment? *

New Camp Staff Application - Page 4
Employment History
Employer's Name
Address
Address
Area Code Phone Number
Position
Position
Dates Employed
Dates Employed
Major Responsibilities
Major Responsibilities
Reason for Leaving
Reason for Leaving
Supervisor's Name
Supervisor's Name
Experience as a Camper or Camp Staff Member:
Camp Name & Location
Organization
Organization
Years
Years
Supervisor Name
Supervisor

New Camp Staff Application - Page 5
REFERENCES: List three (3) persons NOT related to you who can judge your qualifications for this position. If you have previous experience as a camp staff member, one reference should be from a camp director or camp administrator. *
Full Name
Reference Phone Number: *

Area Code Phone Number
Reference E-mail: *
Reference Position Title: *
How long have you known this reference? *
In what way do you know this person? (This person should not be related to you.) *
Reference Name *
Reference Phone Number: *

Area Code Phone Number
Reference E-mail: *
Reference Position Title: *
How long have you known this reference? *
In what way do you know this person? (This person should not be related to you.) *
Reference Name *
Reference Phone Number: *

Area Code Phone Number
Reference E-mail: *
Reference Position Title: *
How long have you known this reference? *
In what way do you know this person? (This person should not be related to you.) *
I understand that employment is contingent on  Report of criminal history from the Pennsylvania State Police (PSP);  Child Abuse History Clearance from the Department of Human Services (Child Abuse); and  Fingerprint based federal criminal history submitted through the Pennsylvania State Police or its authorized agent (FBI). *

Yes No
I certify that all information provided is true and complete. I understand that falsification or significant omission of any information may be considered justifications for dismissal if discovered at a later date. *

Yes No
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2020 Milky Way Farm Summer Day Camp Staff Application

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