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 _________________
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
Last school attended _______________________________________________
Major __________________________ Minor
__________________________
Extracurricular Activities (school related) ______________________________
________________________________________________________________
Page 2
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 Belaying
First
Aid
Instructor
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
Westview on the James