2008 Staff Application

Personal Information

first name: *

last name: *

best phone number to reach you: *

Please enter the best phone number where we can reach you.

phone type:

cell

school

home

work

e-mail address: *

Please enter the best e-mail address at which we can reach you.

home address:

home phone:

age group:

16

17

18+

To facilitate reference checks, are you known to schools, references, or employers by another name?:

yes

no

If yes, what name?:

Have you previously worked with Crossroads for Kids?:

yes

no

If yes, what position?:

program applying for:

position sought:

Education Information

high school attended/attending:

address of high school:

degree/diploma earned:

college or university attending/attended:

major/area of study:

address at college/university:

college degree/diploma earned:

Camp Experience

Please list previous camp experience.
camp name:

camp phone number:

years attended/worked:

list duties/responsibilities:

Please list additional camp experience.
camp name:

camp phone number:

years attended/worked:

list duties/responsibilities:

Work History

Military Service
Have you served in the US Armed Forces?:

yes

no

If yes, from:

to:

branch:

primary duties:

discharge date:

rank at discharge:

Work and Volunteer Experience
Please list present or most current job first. Please include all employment (you may also list volunteer positions).

1. company name, address, and phone:

start date:

end date:

job title and duties:

supervisor's name:

pay:

reason for leaving:

2. company name, address, and phone:

start date:

end date:

job title and duties:

supervisor's name:

pay:

reason for leaving:

3. company name, address, and phone:

start date:

end date:

job title and duties:

supervisor's name:

pay:

reason for leaving:

Please add any additional employment information here.:

Experience

Describe any previous camp experiences you've had as a camper or a staff member.:

Describe any extra-curricular activities you participate in, including volunteer positions.:

Describe any experience you have working with youth (baby-sitting, after school care, volunteer, etc.).:

What do you think young people can learn from a camp experience?:

What qualities do you have that would make you a good Crossroads for Kids camp staff member?:

Given the unusually demanding nature of this job, what do you anticipate will be the stressors and rewards?:

General Program Skills

Rate your skill on a scale from 1-5, with 5 being Excellent.
story telling:

teambuilding:

leading games:

skits/talent show MC:

leading songs:

leading discussions:

conflict resolution:

Please list your skill level in any of the following activity areas:
1-experienceed teacher 2-experienced assistant 3-assistant only (but willing to learn)
Land Sports
soccer:

softball:

basketball:

volleyball:

baseball:

football:

Water Sports
swimming:

canoeing:

sailing:

lifeguarding:

kayaking:

row boating:

Creative Arts
crafts
:

painting:

sewing/fabric arts:

drawing:

jewelry making:

theater:

dance:

musical instruments:

other:

Outdoor Pursuits
archery:

climbing wall:

nature/ecology:

overnight camping:

high ropes:

mountain biking:

farm animals:

fishing:

survival skills:

Computers
Adobe Photoshop:

digital photography:

Dreamweaver:

html:

Flash:

other:

Support Positions
health care assistant:

housekeeping:

laundry:

maintenance:

chef:

assistant chef:

kitchen assistant:

office manager:

Miscellaneous
behavior management
:

radio station:

journalism:

teen programs:

other (not listed above):

Please rate your swimming ability:

excellent

good

fair

non-swimmer

Please list your strongest activity skills below.
skill 1:

skill 2:

skill 3:

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):

yes

no

What is your preferred age group?:

Is there any additional information you would like us to consider as we review your application?:

How did you find out about Crossroads for Kids?:

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):

yes

no

Professional Licenses and Certifications

List all professional registrations, licenses, and certifications relevant to the position you are seeking.
1. professional discipline/area:

license or certificate number:

date obtained:

expiration date:

state/granting authority:

2. professional discipline/area:

license or certificate number:

date obtained:

expiration date:

state/granting authority:

3. professional discipline/area:

license or certificate number:

date obtained:

expiration date:

state/granting authority:

Have you ever been subject to professional disciplinary action or had a registration, license or certification denied, suspended, or revoked either temporarily or permanently?:

no

yes

If yes, explain:

Please ark any current certifications you hold:

Are you interested in taking a lifeguarding course at camp?:

yes

no

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.
Reference 1: name: *

relationship to you: *

phone: *

years known: *

Reference 2: name: *

relationship to you: *

phone: *

years known: *

Reference 3: name: *

relationship to you: *

phone: *

years known: *

Conviction Information

Have you ever been convicted of a felony and/or sexual crime?: *

no

yes

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:

Have you been convicted of a misdemeanor within the past 5 years?: *

no

yes

(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:

Waivers

Do you believe you will be able to adjust to camp culture and lifestyle for the summer?: *

yes

no

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.)

I have read and understand the medical and health insurance requirements.: *

yes

no

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.: *

yes

no

I have applied for employment at Crossroads for Kids, Inc. By completing this application form, I understand that the Camps 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.

Crossroads for Kids

Personal Information

Education Information

Camp Experience

Work History

Experience

General Program Skills

Professional Licenses and Certifications

References

Conviction Information

Waivers

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