Bar 717 - Camp Trinity

Name		Address

First	Last	Street

Social Security #		City	State

Phone Number		Zip Code

Email
How did you find out about the Bar 717 Ranch?


The following questions are optional:

Birth Date (mm-dd-yyyy)	Height	Weight	Marital Status

Sex		Must family accompany you to the ranch?

Age and sex of children if any


EDUCATION (List High School attended and all post High School educational institutions attended)

Name Of School	Major Field	Years	Degree





WORK EXPERIENCE (Including any volunteer work)

Position	Employer	Phone	Dates





EXPERIENCE IN CAMPING (List only jobs with day or resident camps)

Position	Camp Name	Director	Phone	Dates




REFERENCES (NO RELATIVES! Former teaches and employers are preferred

Name	Address	Phone	Position



*Please provide reference form to all references. All forms must be returned for application to be considered.


From the following list, select "teach" by those activities you feel you can organize and teach efficiently, and select “assistance” by those which you have had experience and feel you can offer assistance.

ARTS AND CRAFTS			PRACTICAL SKILLS
	Silk Screen Painting			Welding
	Basketry			Auto Mechanics
	Candle Making			Blacksmithing
	Ceramics			Wood Crafts
	Jewelry			Gardening
	Leather Work			Farming
	Nature Crafts			Animal Husbandry
	Painting/sketching			Baking and Cooking
	Photography/Darkroom (B&W)			Other (Explain)
	Tie Dye
	Batik
	Other (Explain)


OUTDOOR SKILLS AND PIONEERING			SPORTS
	Hiking			Archery
	Extended Backpacking			Fishing
	Overnight Camping			"new" Games
	Trail building/maintenance			Horsemanship
	Other (Explain)			Ropes Course


DRAMA/TEATHER			NATURE
	Story Telling			Wild Animal
	Creative Writing			Birds
	Skits and Stunts			Ecology

MUSIC				Flowers
	Leading Singing			Insects
List Instruments Played				Forestry
				Weather
				Astronomy
				Rocks and Mineral
				Other (Explain)


PERSONAL INFORMATION

Have you ever been arrested for any crime, including sex-related or child-abuse-related offenses?

If yes, what were the charges?


Have you ever departed prior to your contracted completion date or been terminated from any employment?

If yes, please explain below.


Do you smoke?		Do you drink alcohol?
If you answered “yes” to one of the above questions, if hired, could you refrain from smoking or drinking alcohol for the duration of the camp season (8 weeks)?


Do you have any special dietary needs or preferences?

If yes, what are they?


Do you hold any First Aid, CPR or Wilderness First Aid Certification?

If “yes”, give the level of certification and the date of expiration.


Do you hold a Lifeguard Training Certificate or Water Safety Instructor Certificate?

If “yes”, give name and date of expiration.


PLEASE ANSWER THE FOLLOWING QUESTIONS, WE APPRECIATE YOUR THOUGHTFUL RESPONSES:

1. List 5 adjectives that best describe you:


2. Why do you want to be a counselor and what do you expect to gain from this job?


3. Tell us about your strengths and experiences in working with children.


4. How do you define leadership skills? Tell us about a non-work related situation where you were put in a leadership position.


5. Working at our camp is an intense experience that requires many interpersonal skills – one important skill being an ability to work cooperatively with other people. Describe a situation in which your cooperative skills were tested.


6. What is your idea of a good parent? What values and characteristics you posses that make you a good role model for children?



PLEASE READ CAREFULLY EACH PARAGRAPH AND SIGN BELOW:

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize The Bar 717 Ranch to thoroughly investigate my criminal history, driving record, references, work record, education, and other matters related to my suitability for employment and , further, authorize the references I have listed to disclose to The Bar 717 Ranch any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships, and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. In addition, I agree to submit a fingerprint card to the Bar 717 Ranch if offered employment.

I understand that nothing contained in the application, or conveyed during any interview, is intended to create an employment contract between me and the Bar 717 Ranch. In addition, I understand and agree that if I am employed, my employment is at-will and may be terminated at any time, with or without prior notice, at the option of either myself or the Bar 717 Ranch, and that no promises or representations contrary to the foregoing are binding on the camp unless made in writing and signed by me and the Camp Directors.

Initials:

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