Med-O-Lark Staff Application | Arts Summer Camp of New England

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First Name:		ERROR: Required
Last Name:		ERROR: Required
Mailing Address:		ERROR: Required
Permanent Address: (if different from mailing)
City:		ERROR: Required
State:		ERROR: Required
Zip:
Home Phone:		ERROR: Required
Work Phone:
Email:		ERROR: Required
Date of Birth:		ERROR: Required
Height:
Weight:
Gender:	Male Female	ERROR: Required
Do You Have A Driver’s License?:	Yes No	ERROR: Required
Would You Bring A Car To Camp?:	Yes No	ERROR: Required
Drivers License Number:
Issuing State:
Smoker:	Yes No	ERROR: Required
Education (Please include schools attended, major subjects, years, and degree(s) you earned):		ERROR: Required
Camp or related experience (Please include position held, camp information, director information, and dates, experience with children, leadership or volunteer positions):
Please include 2 references:		ERROR: Required

Staff Application

Do you hold a current WSI or Lifesaving Certifate?:	Yes No	ERROR: Required
If so, what dates?
Do you hold a current First Aid or CPR Certificate?:	Yes No	ERROR: Required
If so, what dates?
Please list your best 3 activities and your background in those areas:
Personal Statement or Personal Information:
What do you suppose will be your greatest difficulty at camp:
Do you have any medical conditions, physical disabilities, or allergies?:	Yes No	ERROR: Required
If yes, please explain:
Have you ever been convicted of a crime against or involving children?:	Yes No	ERROR: Required
By submitting this application, the applicant hereby guarantees that all information given via this application are true and were submitted by the applicant. If hired, the applicant may be subject to a background check and if a background check is performed or during employment it is revealed that the applicant supplied false information, employment may be terminated at once.
Captcha:	What is 8 plus two (in numerical format)?:	ERROR: Required