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Upload your picture *

Max file size: 20MB

Date Of Application *

Legal Name *

Social Security # *

Permanent Address *

City *

State *

Zip *

Email *

Home Phone *

Cell Phone *

Age *

Date of Birth *

Place of Birth *

Emergency Contact (other than parents) *

Relationship to Applicant *

Emergency Contact Phone *

Personal Rav *

Family Shul *

Check programs interested in *

Camp Extreme Shabbatons Yom Tov Programs Night Events

Dates Available from *

Dates Available to *

How did you learn about this program? *

Is there a particular person that referred you? *

Past Work History

Provide a full record of all employment – paid and volunteer- Use a separate sheet, if necessary, beginning with most recent:

Dates(#1) *

Employer/Supervisor(#1) *

Address and Phone(#1) *

Nature of Position(#1) *

Date(#2) *

Employer/Supervisor(#2) *

Address and Phone(#2) *

Nature of Position(#2) *

Date(#3) *

Employer/Supervisor(#3) *

Address and Phone(#3) *

Nature of Position(#3) *

References

Give names and addresses of three persons (not relatives) having knowledge of your character, experience, work habits, and ability.

Name(R#1) *

Relationship(R#1) *

Address(R#1) *

Phone(R#1) *

Email(R#1) *

Name(R#2) *

Relationship(R#2) *

Address(R#2) *

Phone(R#2) *

Email(R#2) *

Name(R#3) *

Relationship(R#3) *

Address(R#3) *

Phone(R#3) *

Email(R#3) *

Past Camper Experience

Dates(P#1) *

Camp(P#1) *

Director(P#1) *

Location(P#1) *

Dates(P#2) *

Camp(P#2) *

Director(P#2) *

Location(P#2) *

Dates(P#3) *

Camp(P#3) *

Director(P#3) *

Location(P#3) *

Past Camp Counselor Experience

Dates(PCCE#1) *

Camp & Director(PCCE#1) *

Location(PCCE#1) *

Position(PCCE#1) *

Dates(PCCE#2) *

Camp & Director(PCCE#2) *

Location(PCCE#2) *

Position(PCCE#2) *

Dates(PCCE#3) *

Camp & Director(PCCE#3) *

Location(PCCE#3) *

Position(PCCE#3) *

Education High School and Beyond

Years(EHSB#1) *

School(EHSB#1) *

Major & Minor(EHSB#1) *

Degree Granted(EHSB#1) *

Years(EHSB#2) *

School(EHSB#2) *

Major & Minor(EHSB#2) *

Degree Granted(EHSB#2) *

Years(EHSB#3) *

School(EHSB#3) *

Major & Minor(EHSB#3) *

Degree Granted(EHSB#3) *

Do you have a valid driver’s license? *

State(L) *

License# *

Do you have a commercial driver’s license? *

Do you have a valid passport? *

Issuing Country *

Expiration Date *

Passport Number *

Certification and Camp Support Staff Skills

In the following list please mark with an “E” those items in which you have experience and skills. Mark with a “C” those for which you hold a current certification and attach a copy of your certification (For multiple files, please zip them into one file and upload)

Upload Your File *

Max file size: 20MB

Health Safety

CPR *

First Aid *

Lifeguard *

Nursing *

Other Skills(HS) *

Other(HS): *

Maintenance

Auto Mechanics *

Carpentry *

Electrical *

Plumbing *

Other Skills(M) *

Other(M) *

Food Services

Cooking/meal preparation *

Food handlers permit *

Menu planning *

Purchasing *

Other Skills(FS) *

Other(FS) *

Please tell us something about yourself that sets you apart and makes you most fit for this job. What specific contributions do you think you can make at Project Extreme? *

Have you had experience with teens at-risk? What does the term “at-risk behavior” mean to you? Please explain. *

Please rate the following:

Ability to wake up early *

Ability to follow directions *

Positive Attitude *

Ability to work with others *

Ability to take initiative *

Ability to think creatively *

Commitment to Torah and Mitzvos *

Commitment to Halacha *

Personal Modesty *

Harassment Project Extreme prohibits all forms of harassment by our employees. This includes sexual, racial, religious, and other forms of harassment. Have you been accused of harassment of any person including, but not limited to, workplace harassment? (Note: A prior conviction is not an automatic bar to employment. The type of conviction and when it occurred will be evaluated by Project Extreme before a decision is made.) *

Yes No

Please explain(#1) *

Criminal Record Have you ever been convicted of a crime, other than a minor traffic offense? If yes, please describe. (Note: A prior conviction is not an automatic bar to employment. The type of conviction and when it occurred will be evaluated by Project Extreme before a decision is made.) *

Yes No

Please explain(#2) *

I authorize investigation of all statement herein, including any checks of criminal record, and release Project Extreme and all others from liability in connection with the same. I understand that, if employed, I will be at at-will employee unless there is an agreement or law which alters that status. Furthermore, I understand that any agreement must be in writing and signed by the designated official. I also understand that untrue, misleading, or omitted information herein or in other documents completed by the application may result in dismissal, regardless of the time of discovery by the program. *

Yes No

Full Name *

Date *

Camp Extreme Staff Application 2018

Past Work History

References

Past Camper Experience

Past Camp Counselor Experience

Education High School and Beyond

Certification and Camp Support Staff Skills

Please rate the following: