Work At Camp – Beth El Day Camp

Name*

First Middle Last

Gender*

Male
Female

Age*

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Cell Phone*

Email*

Children/Siblings

Date of Birth*

Social Security #*

Are you a member of Beth El Synagogue Center?*

Yes
No

Have you been at the above address for the last three years?*

Yes
No

If not, please provide addresses for the past three years below.

EDUCATION

Name of School*

Grade/Year Entering in the Fall*

Degrees Held*

Major*

List any extra-curricular activities in which you participate:*

LIST ALL EXPERIENCES WITH CHILDREN*

Type of Experience / Ages of Children / Start and End Dates

Skills*

(Check the activities you enjoy)

Sports
Swimming
Nature
Music
Arts & Crafts
Dance

Please list any skills in which you excel:*

REFERENCES: Please list only non-relatives.*

Title / Relationship / Phone Number & Email

ADDITIONAL INFORMATION

How did you hear about Beth El Day Camp?*

Are you available for the entire summer season?*

Yes
No

Dates Absent*

What size t-shirt do you wear?*

(for our staff shirts- please circle one)

Indicate a first and second choice of age group of children with whom you prefer to work:*

Two Year Olds
Three Year Olds
Four Year Olds
Five Year Olds
Six Year Olds
Seven Year Olds
Eight Year Olds

Have you ever been involved in an incident which resulted in an allegation of sexual abuse?*

Have you ever been involved in an incident which resulted in an allegation of child abuse?*

Have you ever been accused/convicted of a crime?*

Beth El Day Camp will provide equal employment opportunity without regard to race, color, sex, age, disability, religion, national origin, marital status, sexual orientation, ancestry or veteran status.

Date*

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