CAMP EASTER SEALS UCP VIRGINIA Summer Employment Application Please print or type application and return to address above

Transcription

1 Easter Seals UCP North Carolina & Virginia 201 East Main Street Salem, VA Alexander Barge, Camp Director CAMP EASTER SEALS UCP VIRGINIA Summer Employment Application Please print or type application and return to address above We consider applicants for all positions without regard to race, color, national origin, age, gender, religion, marital or veteran status, the presence of a non-job related medical condition or disability, or any other legally protected status. Position(s) Desired: Available Dates: Availability for phone/skype interview: Time of Day: Time Zone: Phone: ( ) PERSONAL INFORMATION: Name: Last First Middle Mailing Address: City: State: Zip: Country: Permanent Address (if different from mailing address): City: State: Zip: Country: Phone: ( ) *********************************************************************** Are you eligible for employment in the United States? Yes No Are you 18 years of age or older? (may be required to provide proof of age) Yes No Have you ever been employed at an Easter Seals or UCP camp before? Yes No If yes, give Date: Location: Position Held: Have you since the age of 18, been convicted of a misdemeanor or felony other than a minor traffic violation? Yes No If yes, please explain: REFERRED BY: Check all that apply Poster/Flyer Location: Instructor/Professor Location: Job/Camp Fair Location: Newspaper Name: Career Center Location: Internet Website Address: Friend/Family Name: Other:

2 EDUCATION High School Undergraduate College/University Graduate or Professional School Vocational Name and Location Years Completed Diploma/Degree Describe Course of study Describe any honors received SPECIAL SKILLS: Campers and staff participate in many programs and activities to provide a meaningful recreational experience. If you were asked to help with any of the following activities, how would you rate your skill level and leadership ability in each area? 1 - Ability to organize and teach activity 2 - Ability to assist in teaching 3 - Some knowledge 4 - No knowledge Climbing/Ropes Course Canoeing Archery/Paint Ball Nature Arts & Crafts Horseback Riding Music/Dance/Drama Swimming Adaptive Sports/Games Please describe any other skills or talents you may have that are not listed that you believe should be noted: CERTIFICATIONS: First Aid: CPR: Lifeguard: Other certifications:

3 EMPLOYMENT: Start with your present or last job. Include any job-related military service assignments and volunteer activities. Also include any previous Camp experience you have had. Please use an additional page if necessary. This section must be complete even if you are attaching a resume. May we contact your present employer? Yes No

4 SHORT ANSWER Please answer all questions completely and accurately. You may use a separate sheet of paper if needed.. 1. Briefly state the reason you desire employment at Camp Easter Seals UCP Virginia. 2. How do you feel working at Camp Easter Seals UCP will assist you in meeting your future goals? Please define these goals. 3. What do you feel is the value of organized camping and recreation for people with disabilities? Please explain your answer. 4. Are there any reasons you would have difficulty performing the essential elements of the job for which you are applying? 5. Would you accept a position other than the one for which you are applying? Why or why not?

5 REFERENCES Three references are required before a position can be offered, two professional/educational and one personal (please no relatives). Please list below the individuals that will be supplying references. APPLICANT S STATEMENT I certify that answers given herein are true and complete to the best of my knowledge. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I also understand, I am required to abide by all rules and regulations of the employer. I hereby understand and acknowledge that unless otherwise defined by applicable law, any employment relationship with this organization is of an at will nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this at will employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. Applicants will be required to provide names, telephone numbers and addresses of professional references. Your signature on this application releases the references from any damage which might result from furnishing personal employment information. Easter Seals UCP s Drug Free Workplace Policy requires all employees to report to work in a substance-free condition. In compliance with this policy, I hereby acknowledge that if I am hired, I may be required to undergo a drug screening by urinalysis. Further, I acknowledge that refusal to do so, or a drug-positive result may be grounds for termination. I also agree to submit to a urinalysis and blood (for alcohol) test if needed in a post rehabilitation recovery periodic test and the required post-accident testing. I understand that if I am extended an offer of employment, it may be conditioned upon my successful passing a complete pre-employment physical examination. I consent to the release of any or all medical information as may be deemed necessary to judge my capability to do the work for which I am applying. All applicants of Easter Seals UCP are required to undergo a criminal history check to be considered for employment with the company. I acknowledge that Easter Seals UCP may be required to provide the results of this check to 3rd party business partners or agencies, and by signing this application I hereby authorize Easter Seals UCP to make such disclosure. Applicant s Signature Date