Personal Information
Name:
How did you learn of Camp Greylock?
E-mail:
Home Address:
City:
State:
Zip:
Home Phone:
 
School Address:
City:
State:
Zip:
School Phone:
Cell Phone Number:
 
Best times to reach you at: Home:
  School:
 
Height:
Weight:
Smoke?
Birthplace:
Citizen of:
Shirt Size:
Are you:
Have Children?
Names/Ages:
Driver's License Number:
State:
Expiration Date:
Social Security Number:
 
Please list any physical limitation/recurring illnesses which would interfere with your ability to perform the job for which you are applying.
 
Have you ever been convicted of a child abuse or sexual abuse offense? If "Yes", give details:
 
Present Occupation
(If student, school & year):
 
Career Objectives:
 

Education
Name of College, graduate school, other school:
 
Major/Degree Attained:
Class Year/Date Graduated:
 
Extracurricular Interests (varsity, intramural, clubs, cultural, other):
 

Certificates
Do you currently hold any American Red Cross Instructor certificates or equivalents:
Please indicate certificates currently held and fax copies to our office (Fax: (212)765-8177 or (413)623-5049)
 
Life Guard Training:
Expiration Date:
 
Water Safety Instructor:
Expiration Date:
 
YMCA Lifeguard:
Expiration Date:
 
Lifeguard BSA:
Expiration Date:
 
Emergency Water Safety:
Expiration Date:
 
Other:
Expiration Date:
 
Other:
Expiration Date:
 

Work Experience/Reference:
Describe any experience you have had working/associating with children. Include the name of the organization, your position and responsibilities, dates of employment, salary, age of children, and the name, address and phone number of your director or supervisor whom we may contact as a reference. Also include any other pertinent information which you would like us to consider.
 

Activity/Specialty
Primary Interest: In which activity program(s) would you most like to lead or assist? Describe fully your training/leadership experience in this area. Information contained in above section need not be repeated.
 
Secondary Interests: In which other camp activities are you especially interested? Briefly describe your training/leadership experience in these areas. Also indicate any skills or talents not previously mentioned that could contribute to the camp experience.
 
Why do you want to be a camp counselor? What qualities do you feel you have which will enable you to fulfill effectively the responsibilities and meet successfully the demands you will encounter as a cabin and activity counselor? Please use this opportunity to include anything else you fell will be valuable in our consideration of your application.
 
Any special consideration, condition or problems concerning your accepting employment at camp? Also use this space for any questions you may wish to ask.
 
The camp dates, including the one week pre-season Staff Orientation are June 17th through August 17th, 2008.. Are you available for this entire period?

If "No", please state why:
 
From around May 26 to June 16 we will offer extra employment opportunities to several staff who would like to help us prepare camp. Please indicate if you would like to join us for this extra pre-camp period.
 
Approximate eight week season salary desired (remember that room and board are included):
 

I understand and agree as follows:

If I am employed: (i) I will follow all Camp Greylock Inc. (“Greylock”) rules and will perform any duties which may be assigned to me at any time; (ii) my employment is for no fixed term and maybe curtailed or terminated at any time in Greylock’s sole discretion for any reason not contrary to law; and (iii) I will work whatever days and hours Greylock requires, subject to applicable law.

I completed this application truthfully and completely. If I have not fully and honestly completed this application, Greylock may reject my application or dismiss me from employment at any time. I authorize Greylock to verify all of my answers to this application.

Any offer of employment I may receive from Greylock is contingent my successful completion of Greylock’s total pre-employment screening process, including Greylock’s receiving references which it considers satisfactory, and my satisfactory completion of any pre-employment physical examination, including the necessary immunizations.

I hereby authorize Camp Greylock Inc. and its associates to obtain any credit, background, or criminal history report[s] on me that they deem necessary.

I release from all liability and responsibility Greylock and those parties supplying information to Greylock, and understand that Greylock (Camp Greylock Inc.) will use reasonable efforts to protect the confidentiality of this personal information.

None of the above provisions may be waived or modified by Camp Greylock Inc. unless in writing and signed by both parties.

I have read and understood the above and agree to it.
Date:
 
Note: Incomplete forms cannot be processed.
 
This information will be held in strict confidence. Should we be unable to offer you a position, may we refer your application to another camp or camps?
 
Thank you for filling out this application. We look forward to speaking with you personally, soon.