STAFF APPLICATION

Hiram House Camp is an equal opportunity employer and does not discriminate because of race, sex, religion, age, marital status, national origin, or disability.

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Age *

over 17

over 21

Last Name *

First Name *

Middle Initial

Permanent Address

Address *

City *

State *

Zip *

Phone *

Current/School Address

Address

City

State

Zip

Phone

Email Address *

To which address should mail be sent *

Permanent

Current/School

Please explain any difficulty you may have in performing any of the essential functions of the job.

Have you previously applied for employment at Hiram House Camp? *

Yes

If yes, when?

Please include year and month.

Have you ever been convicted of a felony? *

Yes

If yes, please describe

Dates you are available to work

From

Month

Day

Year

Month

Day

Year

Any

Are there any days you will be unable to work?

Other Certifications

Education

List the last two schools you have attended or are attending.

School (city, state)

Major Subjects

Degree Granted

Years Attended

School (city, state)

Major Subjects

Degree Granted

Years Attended

How do you feel your education has prepared you for working with children in a summer camp setting?

Why do you want to work with and care for children?

Employment

List all present and past employment, beginning with the most recent.

(1) Name of Business

Address of Business

Phone

Dates of Employment

Job Description

Salary

Reason for Leaving

Name of Supervisor

(2) Name of Business

Address of Business

Phone

Dates of Employment

Job Description

Salary

Reason for Leaving

Name of Supervisor

(1) Name of Business

Address of Business

Phone

Dates of Employment

Job Description

Salary

Reason for Leaving

Name of Supervisor

How has your work history prepared you for a job at summer camp and for dealing with both campers and other staff members?

Why should Hiram House choose you as a staff member?

How did you hear about Hiram House Camp?

Other than through school and employment how are you involved with children?

References

List four personal, professional references who a reference form can be sent by email regarding your work experience, character and ability. Do not include relatives, fellow students or friends of the family. If a reference does not have an email address, please click here to print a form to give them.

References Disclaimer *

I authorize

I authorize Hiram House to seek information regarding my services and character from the references listed below and unconditionally releases the organization from all liability, which might result from furnishing such information.

Name, Company and Position *

Email Address

Home Phone *

Work Phone *

Address *

City *

State *

Zip *

Name, Company and Position *

Email Address

Home Phone *

Work Phone *

Address *

City *

State *

Zip *

Name, Company and Position *

Email Address

Home Phone *

Work Phone *

Address *

City *

State *

Zip *

Name, Company and Position *

Email Address

Home Phone *

Work Phone *

Address *

City *

State *

Zip *

I authorize *

I authorize

I authorize investigation of all statements contained within this application and release the camp and all others from liability in connection with same. I understand that, if employed, I will be an at-will employee, that the employee or employer is free to terminate the agreement at any time and for any or no reason, and that any agreement to the contrary must be in writing and signed by the director of the camp. I also understand that untrue, misleading, or omitted information herein may result in dismissal, regardless of time of discovery by the camp. I further give permission, in accordance with the laws of the State of Ohio, to be fingerprinted and undergo a criminal background investigation, and to undergo any legal drug or physical tests required by the employer.

I agree *

I agree

I have read, understand and agree to follow all customer policies as a member of The Hiram House staff.

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STAFF APPLICATION