Employment Application Step 1 of 4 - Personal Details 0% Contact InformationName* First Last Social Security Number*Email Address* PhoneCell PhoneSkype AddressPermanent Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Alternate Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code To which address should we send mailings?Permanent AddressAlternative AddressDemographicsAgeDate of Birth MM DD YYYY HeightWeightMedical or orthopedic conditions that would limit heavy physical labor?NoYesIf yes, please explain. EducationYearsSchoolMajor SubjectDegree Granted Past EmploymentDatesEmployerAddress and PhoneType of WorkSupervisor Camp ExperienceDatesCampLocationDates Attended/WorkedDirector ReferencesNameAddressPhoneRelationship Please select 1 or more positions from the list below Mountaineering - Rock Climbing/Ropes Corse Instructors- Preference given to rock climbers that can lead climb to 5.9 and able to set basic top rope anchors systems. Aquatics - Director of the Waterfront- Lifeguard certified required, teach swimming and basic canoeing. Aquatics - Kayaking Instructor- Lifeguard certified preferred, teach paddling skills, rolls, basic whitewater skills. Aquatics - Fishing/Fly-Tying Instructor- Fly-fishing and spin-casting, preference to candidate who can teach fly-fishing and fly-tying. Crafts - Woodworking Instructor- Outdoorsman willing to be trained in the use of hand tools and old techniques. Crafts - Blacksmithing Instructor- Outdoorsman with background in metal work, willing to be trained in blacksmith techniques. Shooting - Marksmanship Instructor- Current or ex-military/cadet preferred, ability to lead .22 caliber program. Kitchen - Kitchen Manager- good entry position for individual seeking experience in outdoor leadership We welcome applications from men aged 21 and over who are U.S. citizens. Applicants for the kitchen position can be 18 and older. All staff members (including kitchen staff) live with 6-8 campers, teach or work in specialty area; teaches basic outdoor skills; leads backpacking trips and assists with a canoe trip. Applicants must enjoy living in a primitive outdoor environment; possess high physical energy and enjoy accepting personal challenges.Please explain your experience in the position(s) you selected.What are your experiences working with children?CertificatoinsCertificationCertifying BodyExpiration Date List your certifcations here, such as: Lifeguard, WSI, Basic Water Safety, First Aid, CPR, Kayaking, Canoeing, Rock Climbing, Ropes Course, Outdoor Leadership (NOLS, WEA) InterestsSelect "1" for activities you can organize and teach as an expert, "2" for those activities you can assist with teaching and "3" for those activities which are just a hobby.General Outdoor SkillsOutdoor Living Skills123Outdoor Cooking123Orienteering123Backpacking123Survival Training123Mountaineering SkillsRock Climbing123Lead Rock Climbing123Rappeling123Ropes Course123Tyrolean traverse123CraftsWoodworking123Wood Carving123Metalworking123Blacksmithing123Leatherwork123Fly-Tying123Water SportsSwimming123Canoeing123Kayaking123Fishing123Fly-Fishing123Sports/FitnessFitness Training123Weight Lifting123Cooperative Games123Group Games123Rugby123Soccer123Shooting SportsArchery123Riflery123General CampSong Leading123Story Telling123Musical Instrument123 QuestionsWhat contributions do you think you can make at camp?What contributions do you think a well-run camp can make to children?Do you have a valid driver’s license?*YesNoIf yes, which State?Do you have a commercial driver’s license?*YesNoIf yes, which State?Harassment: The camp’s policy is to prohibit all forms of harassment by our employees. This includes sexual, racial, religious and other types of harassment. Have you ever been accused of harassment of any person including but not limited to, workplace harassment?*YesNoIf yes, explainHave you ever been convicted of a crime, other than a minor traffic offense?*YesNoIf yes, please describeI hereby state that the information contained herein is true, complete and correct. I understand that any misleading information or omission shall be sufficient reason for withdrawal of an offer or subsequent termination of employment. I authorize Roaring Brook Camp to contact all persons named in this application, including employers and references to provide Roaring Brook Camp with any relevant information that may be required to arrive at an employment decision. I understand that consumer reports may be obtained as part of being employed by Roaring Brook Camp. This may include my driving record, an assessment of my insurability under the company’s liability insurance program, or criminal background check. I further understand that I must supply a written record of a medical exam completed within the last year and that I have received required vaccinations to work closely with children. I understand that I must possess my own medical insurance. I understand that any offered contract will be at will of the employer and may be withdrawn at any time, including by June 1st for lack of enrollment. I also attest to the fact I do not smoke cigarettes or use illegal substances. Note: Roaring Brook Camp cannot accommodate special diets, including vegetarian and vegan diets. By entering my electronic signature, I affirm that I have read and agree to the terms and conditions in this application. By entering my electronic signature below, I acknowledge that a criminal background check will be performed on me. 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