Position
(s) applied for (check all that you would consider
____
Junior Counselor ____ Senior Support Staff ____
Senior Counselor
____
Activity Specialist ___ Health Supervisor
____ Lifeguard
Full
Name______________________ Prefer to be called _____________
Social
Security Number _______________ Date of Birth ______________
Your
current mailing address
Your permanent address (if different)
__________________________
____________________________
__________________________
____________________________
__________________________
____________________________
Telephone ( )______________
Telephone ( )_________________
E-Mail
____________________
E-Mail _______________________
Church Affiliation: Church
name_____________________________
Member? ___ Yes ____ No If yes,
our long? ________
Activities you have been involved in at church or in another
religious organization?
_______________________________________________
Education: (circle level
you will have completed as of the end of this school year)
High School - 9 10 11 12 College - 1 2
3 4 5 6
Current school attending ____________________________
Major _________________ Minor
___________________
Extracurricular Activities (school related) ______________________
___________________________________________________________
Skills and Experience
Camp
Experiences
If staff
Dates Attended/
Camper
or Staff? Camp Name
in what capacity Worked
___________________________________________________________
___________________________________________________________
___________________________________________________________
Any
other camping experiences?
___________________________________________________________
Other
Work Experiences:
Where?
Date (s) Worked
Length of Employment
___________________________________________________________
___________________________________________________________
___________________________________________________________
Have you
been convicted of a Misdemeanor of Felony crime? ______ If
yes,
please explain.
___________________________________________________________
___________________________________________________________
Are you
subject to any court order involving sexual or physical abuse of a
minor,
including, but not limited to a domestic order or protection? _____
If yes,
please explain
___________________________________________________________
___________________________________________________________
Driver's
License:
Drivers of camp vehicles must be 21 years of age, have a valid
driver's license and a willingness to take behind the wheel training
and classroom training. If you fulfill these requirements,
please provide the following information.
License #______________________ State
_______________
Have you been convicted of a moving violation within the past three
years? ______ Yes _____ No If yes,
please explain: _______________
___________________________________________________________
If asked
to be a camp driver, a DMV record check will be required.
Certifications:
(Please circle any current certifications)
Standard
CPR Lifeguard Water Safety
Small Craft Archery
First
Aid
Instructor
Belaying
High Ropes Other _______________ Please attach
photo copy of certification (s) with application or bring to
interview.
Major
Interests and Hobbies: __________________________________
__________________________________________________________
Do you
play a Musical Instrument? If so, what ____________________
Are
there any camp related activities that you are willing to teach?
__________________________________________________________
How did
you hear about this job opportunity? _____________________
__________________________________________________________
Why
would you like to work at Westview? ________________________
__________________________________________________________
__________________________________________________________
The position you are applying for will require you to work on Sunday
afternoons and holidays during the Summer camp season. From
Sunday at 2:00 pm through Friday at 9:00 pm, you will be on 24 hour
a day call.
Are you
willing to work such a schedule?_______
Are there any factors which could possibly interfere with your
ability to perform the job for which you have applied (i.e.
any dates during the Summer camp season that you would be unable to
work)?____________
___________________________________________________________
References: List three people with complete addresses - please
use ministers, youth leaders, college professors,
teachers, even camp directors but not family, friends or fellow
students. Please include with your application at least one
letter of reference.
Name
Telephone #
Relationship
___________________________________________________________
___________________________________________________________
___________________________________________________________
All of
the information I have given in applying for this position is true
to the best of my knowledge.
Signature of applicant _________________________ Date ________
Westview
on the James is an equal opportunity employer.
Mail
application to: Westview on the James
1231 West View Road
Goochland, Virginia 23063
or fax:
(804) 457-2178
