Ivy League Staff Application

STAFF APPLICATION

(Please note, fields marked with * are required in order to complete this form)

First Name^*

Last Name^*

Gender

M F

DOB

Social Security #

Position applying for^*

Grade Preference^*

Would you like to drive or supervise a bus

Yes No (you must be 21 to drive a bus)

EDUCATION
High School Name		Year in School

College Name		Major
Years complete of as next June

PROGRAM AREAS SKILLS & EXPERIENCE Please select the Program Areas you have experience or skills in and rate them by selecting the appropriate radio button.
1.	Organize and Teach as an Expert Assist in Teaching Useful Experience
2.	Organize and Teach as an Expert Assist in Teaching Useful Experience
3.	Organize and Teach as an Expert Assist in Teaching Useful Experience
4.	Organize and Teach as an Expert Assist in Teaching Useful Experience
5.	Organize and Teach as an Expert Assist in Teaching Useful Experience
Other	Organize and Teach as an Expert Assist in Teaching Useful Experience

If you have selected "Organize and Teach as an Expert" in any of the areas above, please provide
more information below (i.e. where, when)

CERTIFICATIONS Please select any certifications you may have and list their date issued as well as their expiration date. Also note that we will need copies of all the certifications you hold.
	Certification	Date Issued	Date Expired
	AED
	CPR
	EMT
	EpiPen
	First Aid
	High Ropes/Rappelling
	Lifeguard
	RTE
	WSI
	Other

WORK HISTORY Please list your most recent employment, especially in camping or involving children.
	Work Experience #1	Work Experience #2	Work Experience #3
Dates Employed
Company
Supervisor
Phone Number
Nature of Work
Mailing Address

REFERENCES Please provide the following information of people (NOT RELETIVES) who have knowledge of your character, experience and ability.
	Reference #1^*	Reference #2	Reference #3
Name
Relationship
Phone Number

Please describe any experience working with children or training children.

How will Ivy League benefit from having you as a staff member?

Do you have children of camp age, if so please indicate below.
Child's Name	Age	Gender
		M F
		M F
		M F
		M F

Have you ever been convicted of a crime other than a minor traffic violation?^*

If "yes", please explain in detail

How did you hear about Ivy League?^*

Please Specify

2008 Camp Dates: June 30 - August 22

Do you have any conflicts with the camp dates above?^*

If "yes", please explain

By typing AGREE below and by electronic submission of this application:
1.	I am giving Ivy League Day camp authorization to do a full background search/check.
2.	I certify that all the statements and information on this application are accurate and complete.
3.	I understand that any employment offer is based on the accuracy of this application and if hired I understand that any false statements, omissions or inaccuracies on this application may be cause for dismissal.

Please type "AGREE" here^*