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Camp Mountain Chai
Returning Staff Application

* required fields

  
*First Name:   
*Last 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:   



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)



MISCELLANEOUS INFORMATION

Please take some time to reflect upon last summer and answer the following questions:

I feel my greatest achievement from last summer was...



The thing I have worked on to improve myself in the last year is...



If I could change one thing about last summer it would be...



The top three things (personally or professional) I would change about camp for this year are...




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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