Staff Application for Blue Rill Day Camp, serving Rockland and Bergen Counties and Manhattan

Online Application

Please use the TAB key to go to the next line or change fields.
Do not use the ENTER key until your information is complete.
Required fields are indicated by a red *.

Please be sure that info@bluerilldaycamp.com and staff@bluerilldaycamp.com are on your safe sender list and/or your safe sender domain list so you can receive email from Blue Rill.

Name:	*
Email:	*
Cell Phone:	*
Permanent Address:	*
Permanent City:	*
Permanent State:	*
Permanent Zip:	*
Permanent Phone:	*
Are you over 18 years of age? If not, how old are you?	*

Did someone recommend Blue Rill to you? If so, who?
Are you a former Blue Rill Camper?	Yes No
What type of position do you want at camp?
Are you available for the full eight weeks of camp (Monday, June 30th through Friday, August 22nd)?	Yes No
If not, please explain:

Educational Background

School:
Dates Attended:
Major Subjects:
Degree/Major:

School:
Dates Attended:
Major Subjects:
Degree/Major:

Camp Experience

Camp:
Summers Worked:
Position:
Director:
Phone:

Camp:
Summers Worked:
Position:
Director:
Phone:

Other Employment
(Provide a full record of all employment and explain any gaps in employment in the space provided below.)

Employer:
Dates Worked:
Phone:
Nature of Work:
Supervisor:
Reason For Leaving:

Employer:
Dates Worked:
Phone:
Nature of Work:
Supervisor:
Reason For Leaving:
Please explain gaps in employment (if applicable)

Child-Related Reference
Please list a child-related reference: an adult, non-relative who has seen you working with children i.e. a family that you have baby-sat for, a sports coach, a teacher etc. Blue Rill Day Camp will send out a recommendation form and upon receiving it back, if a position is available, we will contact you for an interview appointment. This section must be completed in order for Blue Rill to review your application. Please note that both reference sections must be fully completed. Please include the email address to help expedite the reference process.

Name:	*
Email:	*
Address:	*
City:	*
State:	*
Zip Code:	*
Phone:	*
How does this person know you?	*

General References
Give names and addresses of 2 persons over 21 that are not relatives having knowledge of your character, experience, and ability. Please note that both reference sections must be fully completed. Please include the email address to help expedite the reference process.

Name:	*
Email:	*
Address:	*
City:	*
State:	*
Zip Code:	*
Phone:	*
How does this person know you?	*

Name:	*
Email:	*
Address:	*
City:	*
State:	*
Zip Code:	*
Phone:	*
How does this person know you?	*

Certifications

Do you hold any of the following certifications?
Lifeguard Training:	Yes No
Issuing Agency:
Date Completed (MM/DD/YY):
Expiration Date (MM/DD/YY):
Water Safety Instructor:	Yes No
Issuing Agency:
Date Completed (MM/DD/YY):
Expiration Date (MM/DD/YY):
CPR:	Yes No
Issuing Agency:
Date Completed (MM/DD/YY):
Expiration Date (MM/DD/YY):
First Aid:	Yes No
Issuing Agency:
Date Completed (MM/DD/YY):
Expiration Date (MM/DD/YY):
Other Certification:
Issuing Agency:
Date Completed (MM/DD/YY):
Expiration Date (MM/DD/YY):
Other Certification:
Issuing Agency:
Date Completed (MM/DD/YY):
Expiration Date (MM/DD/YY):

Special Interests or Skills

Do you have special talents or skills in the following?
Sports: Yes No	Explain talent or skill:
Crafts: Yes No	Explain talent or skill:
Nature: Yes No	Explain talent or skill:
Challenge Course: Yes No	Explain talent or skill:
Woodworking: Yes No	Explain talent or skill:
Photography/Digital Photography/Video: Yes No	Explain talent or skill:
Other:	Explain talent or skill:
Other:	Explain talent or skill:

What contributions do you think you can make at camp?
What contributions do you think a well run camp can make to children?
Write a brief biographical sketch, including specialized training in camping, and experience or training in other fields which might have a bearing on the position(s) to which you are applying.

I authorize investigation of all statements herein and release the camp and all others from liability in connection with same. I understand that, if employed, I will be an at-will employee and that any agreement to the contrary must be in writing and signed by the director of the camp. I also understand that untrue, misleading, or omitted information herein or in other documents completed by the applicant will result in dismissal, regardless of the time of discovery by the camp. I give Blue Rill Day Camp authorization to do a full background search. Yes No
For print out purposes please sign and date. Signature:________________ Date:_________