PLEASE UPLOAD A PHOTO OF YOURSELF

PLEASE FILL OUT ALL INFORMATION & FIELDS

First Name Middle Last

Phone Fax Cell

Home Address City

State Zip

Age Date of Birth (M/D/Y)

Married Single Sex

Height Weight

If Contract is granted and applicant is under 21 years of age at the time of contract, it must be countersigned by parents or guardians.
Parent's Name Address

In Case of Emergency Notify Phone

Address

Medical Insurance Policy Number

Position Desired Salary Requested

Applicant Available from to

*Social Security No.

Schools Attended

High School

Date Entered Year Completed by June

Date (year) Graduated Major Subjects

College

Date Entered Year Completed by June

Date (year) Graduated Major Subjects

Personal References

Do Not Give Relatives or Personal Friends as References.
Enter Name, relationship, address and phone

Reference 1

Reference 2

Reference 3

Activities

In the following list, CHECK each box before those activities you can organize and teach as an expert or assist with.

Athletics

Basketball Football Lacrosse Rugby Gymnastics Soccer Baseball-Softball Tennis Wrestling
Martial Arts Track-Running Hockey Cheerleading Fitness-Wts Aerobics Golf Boxing Frisbee
Yoga-Pilates Other

Aquatics

Canoeing W W Rafting Waterski Inst Lifeguard Fishing Swim Instructor Other

Misc.

Nurse CDL Driver Office Maintenance Kitchen Dining Room Laundry Other

Outdoor Adventure

Rock Climbing Rappeling Rifery Archery Go-Carts Mechanic Mt Boarding Paintball Low Ropes Course
Skate Pro Outdoor Skills Rocketry Other

The Arts

Dance Crafts Drama Arts Photography Video Social Media Computers
Journalism Chess Games Guitar Drums Piano Other

Work Experience (Camp / Recreation / Youth)

Facility Supervisor

Address Phone

Email Positions

Salary Year

Another?

Facility Supervisor

Address Phone

Email Positions

Salary Year

Final Questions

Indicate any camp skills you have

Do you have a current Red Cross (or equivalent) Life Guard Certification? Y or N

CPR? Y or N EMT? Y or N

RN? Y or N LPN? Y or N

Any other certifications pertaining to camp?

Do prohibit the use of intoxicants and tobacco. Are you willing to forgo the use of alcohol or drugs and tobacco while under contract? Y or N

Do you have a valid Driver's license?

Has it been suspended or revoked?

Do you have a valid CDL license?

Have you ever been arrested? Y or N
If Yes, Explain

Have you ever been accused of or involved in an incident involving sexual or physical abuse of a child? Y or N
If Yes, Explain

Is there anything in your medical background to prevent your full participation in our program? Y or N
If Yes, Explain

Are you taking any prescription medication? Y or N
If Yes, What?

Are you prevented for lawfully becoming employed in this country because of a Visa or immigration status? Y or N

BY FILLING OUT THIS APPLICATION YOU ARE AGREEING TO OUR CBR STAFF MANUAL

STAFF APPLICATION

PLEASE UPLOAD A PHOTO OF YOURSELF

PLEASE FILL OUT ALL INFORMATION & FIELDS

Schools Attended

Personal References

Activities

Athletics

Aquatics

Misc.

Outdoor Adventure

The Arts

Work Experience (Camp / Recreation / Youth)

Another?

Final Questions