[Saint Sophia Camp]
2013 Online Counselor / Staff Application
Saint Sophia Camp - Online Counselor / Staff Application
* Denotes required information. Incomplete forms cannot be processed.
* Application for Counselor Staff       Session I Session II

* Position:


Personal Information

* Last name:

* First name:

Middle:

* Home Address:

* City:
      State:       * Zip Code:
* Home Phone:

* Cell Phone:

* Email:

* Home Parish:

     Other Home Parish (include parish name, city and state):
     


Medical Insurance Information

* Do you carry medical insurance?
Yes No

* Medical Insurance Company:
i.e. Anthem Blue Cross, Blue Shield, Health Net, Kaiser, etcetera.

* Policy or group number:

* Social Security number in case of hospital admission (no spaces or dashes):

* Date of Birth:
* Age:

Sex:
Male Female


Emergency Contact Information

* Name:

* Home Address:

* City:
      State:       * Zip Code:
* Home Phone:

* Cell Phone:

Business Phone:


Education

* High School:

* Year Graduated:

* College / University: (spell out, do not abbreviate with initials)

* Major: (spell out, do not abbreviate with initials)

* Years Completed:

* Highest Degree Completed:
       Degree Other: (spell out, do not abbreviate with initials)
      

Camp Experience

Have you ever attended Saint Sophia Camp:
Yes No

If yes, how many year(s) as a camper:

If yes, how many year(s) as a counselor:

If yes, how many year(s) as a staff member:


Have you had any other camp experience:
Yes No

If yes, please explain. If you have been a counselor or staff member, please list each position and years:
i.e. Counselor 2008-2011, Life Guard 2006, Arts & Crafts Director 2007-2009, Assistant Director 2010




Additional Information

Are you certified in CPR/First Aid?:
Yes No
Do you have a lifeguard certificate?:
Yes No

Have you ever held any leadership positions?:
Yes No

If yes, please explain:



Have you ever had any experience working with children?:
Yes No

If yes, please explain:




What are some of your hobbies and interests:




Employment History

[Bullet] Please list all part time and full time employment and volunteer experiences, starting with the most recent.

Company/Organization #01

Company Name:

Address:

City:
      State:       Zip Code:
Phone Number:

Contact Person:

Start Date (Month/Year):

End Date (Month/Year):

Job Title:

Major Responsibilities:





Company/Organization #02

Company Name:

Address:

City:
      State:       Zip Code:
Phone Number:

Contact Person:

Start Date (Month/Year):

End Date (Month/Year):

Job Title:

Major Responsibilities:





Company/Organization #03

Company Name:

Address:

City:
      State:       Zip Code:
Phone Number:

Contact Person:

Start Date (Month/Year):

End Date (Month/Year):

Job Title:

Major Responsibilities:





Company/Organization #04

Company Name:

Address:

City:
      State:       Zip Code:
Phone Number:

Contact Person:

Start Date (Month/Year):

End Date (Month/Year):

Job Title:

Major Responsibilities:





Company/Organization #05

Company Name:

Address:

City:
      State:       Zip Code:
Phone Number:

Contact Person:

Start Date (Month/Year):

End Date (Month/Year):

Job Title:

Major Responsibilities:



    
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