Staff Application - Genesee Valley Rotary Camp

Name*

First Last

Email*

Date of Birth*

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Sex

M

F

Gender*

Gender – other*

Pronouns

Permanent Address*

Street Address Address Line 2 City State ZIP Code

If college student, please list Home address

Phone*

Years of completed education as of August 1st of this year.*

High School

College

Graduate

Vocational Training*

What type?

College major/degree(s) (if applicable)

Present Job Status*

How did you hear about GVRC?*

Why are you interested in working at GVRC?*

What do you hope to gain from working at this camp?*

What previous experience(s) have you had working with individuals that have disabilities?*

What are your interests?*

Other personal experiences you’ve had that would benefit you as a GVRC staff member*

Previous camp/camping experience(s)*

Any physical limitations or health concerns?*

If Yes, please describe*

Special Talents/Awards?

List any certifications you hold (i.e. CPR, First Aid, Lifeguarding)

Click the + sign at right to add additional certifications

Are you applying for a specific position at camp?*

Which Position?

Are you willing to accept any position?

If no, please explain

Have you ever been convicted of a crime, including a sex related or child abuse related offense?*

If Yes, please explain

REFERENCES

Required References*

The reference form must be completed and returned for all applications. Choose two (2) references that are aware of your employment record or if not employed, you may choose character references (non-family members only). Although not required, one preferred reference is someone associated with GVRC or Rotary International. The forms may be sent directly to the camp director, you will receive an email after your submission with mailing information. You may also upload these forms here.

Reference #1 Name

Phone

Reference #2*

Reference #2 Name

Phone

NOTE: A rule that is strictly enforced at GVRC, is that no staff member may consume alcohol or use non-prescribed medications or illegal drugs during the week of camp. This rule is to ensure the safety of all our campers. Any staff member in violation of this rule will be asked to leave the camp immediately. Having read the above statement and having answered all of the questions accurately and honestly, I submit this application. My signature below also indicates my consent for necessary legal background checks required for my employment as a staff member at GVRC.

Name*

First Last

Date

Signature*

(use mouse or finger to sign)

GVRC Staff Application

REFERENCES