Wildwood Hills Ranch - Staff Application Form

Thank you for your time in filling out this application. Please provide as much information as possible so that we may evaluate your application properly.

Wildwood Hills Ranch Summer Staff Application - (** Indicates Required Field - if you only have one email address please use first Email field)

Staff Training is Mandatory: Friday May 28– Friday June 4, 2010.

Please check which session you would prefer (Session One, Session Two or Both).

Session One: June 6– July 9, 2010

Session Two: July 5– Aug 13, 2010

Both Sessions

PERSONAL INFORMATION

Date:**

Gender:

Male:

Female:

First Name:**

Last Name:**

Home Phone:**

Cell Phone:

Other Phone:

Current Address:

City

State

Zip

Permanent Address:

City

State

Zip

Email:**

Second Email:

Do you speak a foreign language?

Yes:

No:

If so please list:

Do you have any physical or emotional limitations that may limit your ability to perform the strenuous requirements of serving at Wildwood Hills Ranch? If yes, please use the text box at right to explain. If no, leave blank.

Position Applying for:

(see website for list of jobs available and descriptions)

Do you meet or exceed any minimum age requirements for that position?

Yes:

No:

Don’t know minimum age

Earliest Date Employable:

Latest Date Employable:

Applicable only to those interested in driving for Wildwood Hills Ranch

Drives License Number:

Drivers License State:

Type of Vehicle:

Moving Violations:

Have you ever been convicted of a Crime?

Yes:

No:

Have you ever been convicted of Sexual Misconduct?

Yes:

No:

If Yes Please Explain:	If Yes Please Explain:

Are you legally able to work in the US?

Yes:

No:

Experienced working at this camp/other camps?

Yes:

No:

Which years worked at this camp?

Years as a Camper:

Years as an LiT:

Years as a TLiT (formally CiT):

EMPLOYMENT EXPERIENCE (most recent first)

Employer 1

Position

Supervisor

Phone

From (Mo/Yr)

To (Mo/Yr)

Full Time

Part Time

Responsibilities:

Hours per week:

Reasons for leaving:

Employer 2

Position

Supervisor

Phone

From (Mo/Yr)

To (Mo/Yr)

Full Time

Part Time

Responsibilities:

Hours per week:

Reasons for leaving:

Employer 3

Position

Supervisor

Phone

From (Mo/Yr)

To (Mo/Yr)

Full Time

Part Time

Responsibilities:

Hours per week:

Reasons for leaving:

Personal References - (Please do not include relatives)

Reference 1 (First and Last Name)

City

State

Home Phone

Work Phone:

Email:

Relationship with Applicant:

Years known?

Reference 2 (First and Last Name)

City

State

Home Phone

Work Phone:

Email:

Relationship with Applicant:

Years known?

Reference 3 (First and Last Name)

City

State

Home Phone

Work Phone:

Email:

Relationship with Applicant:

Years known?

EDUCATION

School 1 Name:

School Address:

City:

State:

Zip:

If High School, what grade are you currently enrolled?

If College, what is your major/completed degree?

From (Month/Year):

To (Month/Year):

School 2 Name:

School Address:

City:

State:

Zip:

If High School, what grade are you currently enrolled?

If College, what is your major/completed degree?

From (Month/Year):

To (Month/Year):

Applicable only to those who have served in the Military

Which Branch of the Military did you serve?

Military Service From (MO/YR)

Military Service To (MO/YR)

EXTRACURRICULAR ACTIVITIES

Please list or explain any extra curricular activities that you are/have been involved. Let us know your experience level (beginner, intermediate or advanced and if you are willing to teach)

Arts/Craft:

Archery:

Canoeing:

Creative Drama:

Gardening:

Music:

Nature Instruction:

Painting:

Photography:

Ropes Course:

Swim lessons:

Large Group Activity/Games:

LEADERSHIP ACTIVITIES AND ORGANIZATIONS - Tell us a little about any leadership roles/opportunities you have had.

CERTIFICATIONS - Please select any certifications you may have. Please also list the date issued and the expiration date, if applicable)

CPR

Expiration date

Lifeguard

Expiration date

WSI Water Safety Instruction

Expiration date

First Aid

Expiration date

Life Saving

Expiration date

Other Certifications
(list in text box)

Others

What do you consider to be your main qualifications for the position for which you are applying?

What contributions do you think a well run camp can make to children?

APPLICANT'S CERTIFICATION

I certify that, to the best of my knowledge and belief, the answers given by me to the foregoing questions and statements made by me in this application (and accompanying resume, if any) are correct and complete. I understand that misrepresentation or omission of facts in this application may disqualify me from further consideration for employment, and may result in my discharge from employment, if discovered at a later date.

I understand that if I am employed, my employment may be terminated at any time by either myself or Wildwood Hills Ranch for any reason, with or without notice. I agree that, should I be employed, said employment will be at-will and will not be governed by any contract, either express or implied.

I hereby authorize Wildwood Hills Ranch or its designee to contact any or all of my references, churches, youth organizations, charities and former employers to inquire about my past job performance, education, personal character and any other topic deemed relevant by Wildwood Hills Ranch. I hereby authorize and agree that a criminal background check be conducted. I further agree that I will hold those individuals and entities who respond to requests for information harmless for any information they provide as a result of such contact, and release them from liability for the result of any such information. I hereby waive any right that I may have to inspect any information provided about me by any person or organization in the course of complying with this authorization.

I agree to furnish such additional information and complete such examinations as may be required to complete my employment file. I also expressly consent to submit to any physical examination that may be required of me, including drug and/or alcohol testing upon request both prior to and, if employed, during employment with Wildwood Hills Ranch. If I am employed, I understand and agree that I will be bound by the policies of Wildwood Hills Ranch.

Applicant’s Signature: (please enter your full name)**

By entering your full name and submitting this application you hereby agree to the terms set forth in the applicant's certification above.

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