900 Dobbs Ferry Rd. White Plains, NY 10607 Tel: 914-592-6121 Fax: 914-592-2195
Contact Us
First Name:
Last Name:
Social Security #:
Gender:
Male
Female
Home Address
Street:
City:
State:
NY
CT
Zip:
Home Phone:
Cell Phone:
E-mail Address:
Date of Birth:
Current Year in School:
HS Junior
HS Senior
College Freshman
College Sophmore
College Junior
College Senior
Graduate Student
n/a
College Address: (If applicable):
Earliest to Latest Dates Available:
How did you hear about Elmwood?
Applying for (Select all that apply):
Group Counselor
Gymnastics Specialist
Swim Specialist
Arts & Crafts Specialist
Drama Specialist
Nature Specialist
Dance/Movement Specialist
Maintenance / Kitchen
Music Specialist
Office Assistant
Athletic Specialist
Certifications (Select all that apply):
Lifeguarding
WSI
First Aid
CPR
RTE
Driver Information:
If you are over 20 yrs. old, are you interested in driving a 16-20 passenger bus of campers?
No
Yes
Would you like to be a bus counselor?
No
Yes
Do you have a Commercial Driver's License?
No
Yes
Educational Background:
Institution
Major
Graduation Date
High School
College
Graduate
Special
List all employment/volunteer experience and provide the following:
1. Name of employer:
Position:
Supervisor:
Years:
2. Name of employer:
Position:
Supervisor:
Years:
3. Name of employer:
Position:
Supervisor:
Years:
Camp(s) attended:
What are your two most important accomplishments? Why did you choose these?
Tell us what you enjoy doing in life.
Tell us about a person or an event in your life that has influenced you.
What would your friends/family say they have learned from knowing you?
For each of the following activities, write a "4" if you are qualified to teach or assist the activity and could head the program, "3" if you are excellent in the activity, "2" if you feel you can assist in leading the activity and "1" if you are familiar with the activity but cannot teach it.
Basketball
Music
Cooking
Softball
Drama
Ceramics
Hockey
Dance/Mvt.
Nature
Soccer
Swim
Ropes Course
Gymnastics
Arts&Crafts
Is there any other activity(ies) you feel qualified to teach?
Have you ever been accused of or involved in an incident involving sexual or physical abuse of a child?
Select One
No
Yes
Have you ever been convicted of a felony?
Select One
No
Yes
If you answered "yes" to either of the last two questions, please explain.
Select One
Yes
No
The information given in this application is correct. If I am hired for a position at Elmwood Day Camp, I understand that providing false information in this application would be cause for my dismissal.
