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Camp Mountain Chai Staff Application
* required fields

  
* Name:   
Position Applying For:   
Are you over 18?    Yes  No
If yes, what is your age?   
Date of Birth:   
Gender:    Male  Female
* Email Address:   
* Cell Phone Number:   



PERMANENT ADDRESS
Street Address:   
City:   
State:   
Zip Code:   
Phone:   



CURRENT ADDRESS
At this Address until:   
Street Address:   
City:   
State:   
Zip Code:   
Phone:   



EDUCATIONAL BACKGROUND
High School
Name of Institution
Years Attended Year Graduated Degrees Major Minor
College/University
Name of Institution
Years Attended Year Graduated Degrees Major Minor
Graduate Work
Name of Institution
Years Attended Year Graduated Degrees Major Minor
Other
Name of Institution
Years Attended Year Graduated Degrees Major Minor



CAMP EXPERIENCE
As a Camper:
  Name of Camp Location Age(s) Attended Year(s) Attended
1.
2.

As a Staff Member:
  Year(s) Name of Camp Position Salary Supervisor Phone#
1.
2.
3.



PERSONNAL BACKGROUND
Jewish Education:
  School Location # Yrs Studied Graduation/Degree
1.
2.

Jewish Knowledge: (Excellent, Good, Fair, Poor)
History Customs Ritual Tradition Prayer

Can you help prepare a Shabbat Service?    Yes   No

Extra-Curricular Activities:
Please describe any extra-curricular activities (ex. youth groups, athletics, school clubs, community service, volunteer work, etc.) and current organization affiliations. Describe any leadership positions held.



Work Experience: (list all previous work experience)
  Position Employer Address Dates Supervisor
1.
2.
3.



CERTIFICATIONS
(Please mail photocopies of all current certifications)

Driver's License #:   State:   Expiration Date:

First Aid, C.P.R. or B.L.S. (Please indicate certifications and expiration dates):



Waterfront (Please check and indicate expiration date):
A.L.S.
W.S.I.
Other (specify)



SKILLS AND QUALIFICATIONS INVENTORY

Considering the camp program and position applying for,

Select "1" for those activities which you can organize and teach.
Select "2" where you feel you can assist in teaching.

Athletics

Archery Basketball Baseball Mountain Biking
Fishing Football Golf Karate/Judo
New Games Soccer Softball Track and Field
Volleyball Other  

Waterfront

Canoeing Diving Kayaking Lifesaving
Snorkeling Swimming Water Polo Other

Music

Piano Play By Ear Accompany Sight Read
Drums Guitar Rock Band Other
Songleading (camp songs) Songleading (Hebrew songs)

Arts and Crafts

Batik Cartooning Ceramics Drawing
Handicrafts Jewelry Macramé Painting
Paper Maché Pottery Sculpture Sewing
Silkscreen Weaving Woodworking Other

Outdoors Adventure

Backpacking Camp Craft Outdoor Cooking Orienteering
Survival Skills Knot Tying Rock/Wall Climbing Ropes Course
Hiking/Overnight Camping Other  

Media

A-V Equipment Set-up Computers Creative Writing
Darkroom Developing Internet Newspaper
Photography Radio Broadcasting Lighting
Video Production Other  

Nature/Science

Animals Astronomy Ecology Nature Study
Other  

Dance

Aerobics American Folk Cheerleading Ballet
Choreography Jazz/Modern International Folk Israeli Folk
Other  

Drama/Performance Arts

Acting Circus Arts Costuming Creative Dramatics
Directing Juggling Lighting Music
Puppetry Stage Craft Storytelling Skit and Stunts
Other  

Miscellaneous

CPR First Aid Typing Leadership Training
Other  

Please list any activities or games you can teach that are not listed:



Do you have or are you willing to obtain a commercial driver's license?
I have a CDL with passenger endorsement.
I am willing to obtain a CDL with passenger endorsement

How did you find out about Camp Mountain Chai?






REFERENCES

Please include references who know of your qualifications and skills, or have supervised you in a professional capacity and can attest to your character. References who can evaluate your work with children, such as former employers, teachers, rabbis or school coun selors are preferred. Do not use relatives, friends or neighbors as references. Applications are not considered complete if a reference does not include a full mailing address and current telephone number. Please list at least three references.
  Reference Name Your
Relationship
to Reference
Known for
How Long?
Phone# Address
1.
2.
3.

I hereby authorize CMC to check all my educational, personal, and employment references as indicated below. I further authorize these references to release to you all information they have about me.
Signature (type your name) Date:

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

If yes, please explain.






MISCELLANEOUS INFORMATION

Please describe how you would be able to positively affect the lives of our campers:



This application is not a contract of employment.
Please note that California is an at-will state.

Have you ever been convicted of a crime? Yes   No

If yes, please mail a separate sheet giving full details.

I certify that the above information is true and accurate to the best of my knowledge. I understand that if employed, it will become part of my personnel file and that any misstatement of fact or falsification may be cause for my immediate dismissal. I also acknowledge that Camp Mountain Chai programs provide a smoke-free environment and that smoking is not permitted on camp grounds. I also understand that application to work at Camp Mountain Chai indicates my ability to refrain from smoking during my time in camp. I also give Camp Mountain Chai my permission to run a criminal background check.

Signature (type your name) Date:

Please type the letters shown in the box below:








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