2010 Summer Staff Application

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2010 Staff Summer Application

	Thank you for applying to work with a Crossroads for Kids program this summer. NOTE: There is no way to save your application. Please plan on completing it in one sitting. Fields marked with (*) are required.
First Name (*)	Invalid Input
Last Name (*)	Invalid Input
E-mail Address (*)	Invalid Input
Best Phone Number to Reach You (*)	Invalid Input
This is my	cell phone.home phone.school phone.other. Invalid Input
Home Address	Invalid Input
Home Phone	Invalid Input
Age Group: Some of our positions have minimum age requirements, please e-mail staff@crossroads4kids.org for more information.	16 17 18+ 21+ Invalid Input
Have you previously worked for Crossroads for Kids?	noyes Invalid Input
If yes, what position?	Invalid Input
To facilitate reference checks, are you known to schools, references, or employers by another name?	noyes Invalid Input
If yes, what name?	Invalid Input
For which program are you applying to work?	Invalid Input
	If you would like more information about each of our programs, click here (will open in new window). Each of our programs offers a unique experience to campers and staff alike. Please contact us at staff@crossroads4kids.org if you have specific questions about which program is the best fit for you.
Position Sought	Invalid Input
Earliest Date Available	Invalid Input
Latest Date Available	Invalid Input
	Education Information
High School Attended/Attending	Invalid Input
Address of High School	Invalid Input
Degree/Diploma Earned	high school diploma GED in progress other Invalid Input
other	Invalid Input
College or University Attended/Attending	Invalid Input
Major/Area of Study	Invalid Input
Address at College/University	Invalid Input
College/University Degree Earned	Invalid Input
	Camp Experience Please list previous camp experience.
Camp Name	Invalid Input
Camp Phone Number	Invalid Input
Years Attended/Worked	Invalid Input
List Duties/Responsibilities	Invalid Input
	Please list additional camp experience.
Camp Name	Invalid Input
Camp Phone Number	Invalid Input
Years Attended/Worked	Invalid Input
List Duties/Responsibilities	Invalid Input
	Work and Volunteer Experience Please list present or most current job first. Please include all employment (you may also list volunteer positions).
Company Name	Invalid Input
Company Phone Number	Invalid Input
Company Address	Invalid Input
Start Date	Invalid Input
End Date	Invalid Input
Job Title	Invalid Input
Duties	Invalid Input
Supervisor\'s Name	Invalid Input
Pay	Invalid Input
Reason for Leaving	Invalid Input

Company Name	Invalid Input
Company Phone Number	Invalid Input
Company Address	Invalid Input
Start Date	Invalid Input
End Date	Invalid Input
Job Title	Invalid Input
Duties	Invalid Input
Supervisor\'s Name	Invalid Input
Pay	Invalid Input
Reason for Leaving	Invalid Input

Company Name	Invalid Input
Company Phone Number	Invalid Input
Company Address	Invalid Input
Start Date	Invalid Input
End Date	Invalid Input
Job Title	Invalid Input
Duties	Invalid Input
Supervisor\'s Name	Invalid Input
Pay	Invalid Input
Reason for Leaving	Invalid Input
	Work History Military Service
Have you served in the US Armed Forces?	noyes Invalid Input
If yes, from when?	Invalid Input
To when?	Invalid Input
Discharge Date	Invalid Input
Rank at Discharge	Invalid Input
Which Branch?	Invalid Input

Please include any additional employment information here.	Invalid Input
	Experience
Please describe any extra-curricular activity participation, including volunteer positions.	Invalid Input
Primary Duties	Invalid Input
Please list/describe any leadership experiences you have had.	Invalid Input
Describe any experience you have working with youth (baby-sitting, after school care, volunteer, etc.).	Invalid Input
What do you think young people can learn from a camp experience?	Invalid Input
What qualities do you have that would make you a good Crossroads for Kids camp staff member?	Invalid Input
Given the unusually demanding nature of this job, what do you anticipate will be the stressors and rewards?	Invalid Input
	General Program Skills Please rate your skill in the following areas on a 1-5 scale (with 5 being Excellent).
Story Telling	12345 Invalid Input
Team Building	12345 Invalid Input
Leading Games	12345 Invalid Input
Skits/Talent Show MC	12345 Invalid Input
Leading Songs	12345 Invalid Input
Leading Discussions	12345 Invalid Input
Conflict Resolution	12345 Invalid Input
	Please list your skill level in the following areas. 1-experienceed teacher 2-experienced assistant 3-assistant only (but willing to learn)
	Land Sports
Soccer	123 Invalid Input
Softball	123 Invalid Input
Basketball	123 Invalid Input
Volleyball	123 Invalid Input
Baseball	123 Invalid Input
Football	123 Invalid Input
	Water Sports
Swimming	123 Invalid Input
Sailing	123 Invalid Input
Kayaking	123 Invalid Input
Canoeing	123 Invalid Input
	Creative Arts
Crafts	123 Invalid Input
Painting	123 Invalid Input
Sewing/Fabric Arts	123 Invalid Input
Drawing	123 Invalid Input
Jewelry Making	123 Invalid Input
Drama/Theater	123 Invalid Input
Dance	123 Invalid Input
Musical Instruments	123 Invalid Input
Other	Invalid Input
	Outdoor Pursuits
Archery	123 Invalid Input
Climbing Wall	123 Invalid Input
Nature/Ecology	123 Invalid Input
Overnight Camping	123 Invalid Input
High Ropes	123 Invalid Input
Mountain Biking	123 Invalid Input
Farm Animals	123 Invalid Input
Fishing	123 Invalid Input
Survival Skills	123 Invalid Input
	Computers
Adobe Photoshop	123 Invalid Input
Digital Photography	123 Invalid Input
Dreamweaver	123 Invalid Input
HTML	123 Invalid Input
Flash	123 Invalid Input
other	Invalid Input
	Support Positions
Health Care Assistant	123 Invalid Input
Laundry	123 Invalid Input
Housekeeping	123 Invalid Input
Maintenance	123 Invalid Input
Chef	123 Invalid Input
Assistant Chef	123 Invalid Input
Kitchen Assistant	123 Invalid Input
Office Manager	123 Invalid Input
	Miscellaneous
Behavior Management	123 Invalid Input
Journalism	123 Invalid Input
Other (not listed above)	Invalid Input
Please rate your swimming ability.	ExcellentGoodFairNon-swimmer Invalid Input
	Please list your strongest activity areas below.
Skill 1:	Invalid Input
Skill 2:	Invalid Input
Skill 3:	Invalid Input

Have you had any experience working with children with behavioral or emotional difficulties, children from at-risk populations, or children in crisis? (e.g. homeless children, victims of abuse)	yesno Invalid Input
What is your preferred age group?	5-67-89-1112-1314-16Any Age Group Invalid Input
Is there any additional information you would like us to consider as we review your application?	Invalid Input
How did you find out about Crossroads for Kids?	Invalid Input
Would you be available to attend a personal interview in the Boston area? (while we prefer to meet you in person, we can also conduct an interview by telephone)	YesNo Invalid Input

	Professional Licenses and Certifications List all professional registrations, licenses, and certifications relevant to the position you are seeking.
Please mark any current certifications you hold:	high/low ropes canoe lifeguard teaching license social worker responding to emergencies (RTE) First Aid (Red Cross) First Aid (YMCA) CPR Water Safety Instructor (WSI) Registered Nurse (RN) Food Service ServSafe Invalid Input
1. professional discipline/area	Invalid Input
license or certificate number:	Invalid Input
date obtained:	Invalid Input
expiration date:	Invalid Input
state/granting authority:	Invalid Input

2. professional discipline/area:	Invalid Input
license or certificate number:	Invalid Input
date obtained:	Invalid Input
expiration date:	Invalid Input
state/granting authority:	Invalid Input

3. professional discipline/area:	Invalid Input
license or certificate number:	Invalid Input
date obtained:	Invalid Input
expiration date:	Invalid Input
state/granting authority:	Invalid Input
Have you ever been subject to professional disciplinary action or had a registration, license or certification denied, suspended, or revoked either temporarily or permanently?	NoYes Invalid Input
If yes, explain:	Invalid Input

Are you interested in taking a lifeguarding course at camp?	YesNo Invalid Input
	References
	Name three people, not relatives or other applicants, who know you well. These are the people who we will contact in regards to your character and experiences in working with youth. (We require three references. If you would like to put a fourth, it could expedite your application process. Leaving the fourth reference blank will not impact your standing in the hiring process.)
Reference 1 name: (*)	Invalid Input
relationship to you: (*)	Invalid Input
phone: (*)	Invalid Input
years known: (*)	Invalid Input
Reference 2 name: (*)	Invalid Input
relationship to you: (*)	Invalid Input
phone: (*)	Invalid Input
years known:	Invalid Input
Reference 3 name: (*)	Invalid Input
relationship to you: (*)	Invalid Input
phone: (*)	Invalid Input
years known: (*)	Invalid Input
Reference 4 (optional) name:	Invalid Input
relationship to you:	Invalid Input
phone:	Invalid Input
years known:	Invalid Input
	Conviction Information
Have you ever been convicted of a felony and/or sexual crime? (*)	NoYes Invalid Input
	Criminal convictions are not an absolute bar to employment, but will only be considered in relation to the specific job requirements of the position for which you have applied. An applicant for employment with a sealed record on file with the commissioner of probation may answer \'no\' with respect to an inquiry herein relative to prior arrests, criminal court appearances or convictions. In addition, any applicant for employment may answer \'no\' with respect to any inquiry relative to prior arrests, court appearances and adjudications in all cases of delinquency or as a child in need of services, which did not result in a criminal conviction.
If yes, give date(s) and explain:	Invalid Input
Have you been convicted of a misdemeanor within the past 5 years? (*)	NoYes Invalid Input
	(Do not include a first conviction for drunkenness, simple assault, speeding, minor traffic violations, affray, disturbances of the peace, or actions related to civil disobedience).
If yes, give date(s) and explain:	Invalid Input
	Waivers
Do you believe you will be able to adjust to camp culture and lifestyle for the summer? (*)	YesNo Invalid Input
	As a staff member working at Camp Crossroads for Kids, Inc., you will be giving up a great deal of privacy and comfort, working long and demanding hours, adhering to camp policies which may be limiting and not necessarily reflect your way of living (i.e. curfews, time off, time on, no smoking, no drinking alcohol etc.). Crossroads for Kids is committed to providing a safe and healthy environment for campers, staff, and stakeholders. I agree to uphold a drug-free, alcohol-free, and tobacco-free work and living environment that also prohibits weapons or firearms anywhere on the premises. I understand that this applies both on camp property and when off the camp site as part of a Crossroads for Kids trip or travel program. I am dedicated to being a role model for the youth Crossroads for Kids serves.
I have read and understand the medical and health insurance requirements. (*)	YesNo Invalid Input
	I understand that in order to be considered for employment at a Crossroads for Kids, Inc. summer program, I need to have a physical examination conducted by a licensed physician within the 24 months prior to the start of camp. I also acknowledge that I need to have my own health insurance to cover any pre-existing conditions, common ailments (i.e. not injured on the job), or personal medications that I may need while I am at camp. I understand that failure to comply with these requirements may render me ineligible to be employed by Crossroads for Kids, Inc.
I understand that by submitting this application, I understand that Crossroads for Kids, Inc. will conduct checks into my background. (*)	YesNo Invalid Input
	I have applied for employment at Crossroads for Kids, Inc. By completing this application form, I understand that Crossroads may wish to contact state and local police, my former employers, educational instructors, and references as indicated on the application to inquire about my past records and characteristics as they may relate to the position for which I am applying. I understand the purpose of this inquiry will be to obtain information so that my qualifications for employment may be reviewed, evaluated and considered. In agreeing to this waiver, I expressly authorize Crossroads for Kids, Inc. to make an inquiry of the state and local police, my former employers, educational institutions, and references as indicated on this application. I also understand that I will be required to provide a background check signed by my local police station if I live outside the state of Massachusetts. The information will be kept confidential.
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