Changing lives and making memories since 1920!

Camp Hazen YMCA Staff Application

Thank you for making the best decision of your LIFE!

Please fill out the online application completely and to the best of your ability!

Personal Information

First Name
Last Name
Email
Home Phone
Cell Phone

Current Address

Street
Town
State
Zip/Postcode
Country
At Current address until:

Home Address:
Street
Town
State
Zip/Postcode
Country

18 years or older?	Yes No
21 years or older?	Yes No
Are you male or female?	Male Female

Start Date

End Date

Education and Certifications

Please list your educational history, starting with most recent:

School

Major

Dates Attended

Honors and Extracurricular Activities:

School	Major
Dates Attended
Honors and Extracurricular Activities:

Please Indicate your current certifications
	Expir. Dates
Archery Certification
CT Public Service License
Lifeguarding
CPR
First Aid
Small Craft Certification
Wilderness First Aid
Wilderness First Responder
Waterfront Safety Instructor
Other:
Other:

Job Position

Please list the position for which you are applying:

If applying for a second position, please select:

Please indicate how you heard about Camp Hazen YMCA:

Skills Information

Let us know what your skills are! Please use the drop down menu next to each selection to let us know which activities you would be able to TEACH or ASSIST. If you are not comfortable teaching or assisting, please leave the selection blank.

Creative Arts

Arts and Crafts	Basketry
Beading	Candlemaking
Costuming	Dance
Directing	Drama
Guitar	Jewelry
Juggling	Leatherwork
Music	Painting
Photography	Puppetry
Radio Program	Rocketry
Tie Dye	Set Design

Land Sports

Aerobics	Archery
Badminton	Baseball
Basketball	Cricket
Fitness	Floor Hockey
Rollerblading	Kickball
Pickle Ball	Skateboarding
Soccer	Softball
Tennis	Ultimate Frisbee
Volleyball	Yoga

Outdoor Pursuits

New Games	Camping Skills
Climbing Wall	Fishing
High Ropes	Low Ropes
Mt. Biking	Mt. Boarding
Outdoor Survival	Orienteering
Outdoor Cooking	Rappelling
Rock Climbing

Water Sports

Canoeing	Kayaking
Sailing	Snorkeling
Swim Instruction	Windsurfing
Water Polo	Water Games

Other Skills

Astronomy	Cabin Chats
Conservation	Ecology
Environmental Ed	Gardening
Group Games	Harmonica
Nature Study	Song Leading
Story Telling

Support Areas

Carpentry	Cleaning
Cooking	Dishwashing
Driving	Landscaping
Laundry	Nursing
Office Skills	Painting
Plumbing	Salad Prep

From the selections you have made above, identify the top two skills that you are capable of teaching at camp. Describe all personal or teaching experience you have in connection with these skills.

I would be best at teaching this because...

I would also be good at teaching this because...

Professional and Camping Experience

Please list most recent employment:

Employer	Address	Phone Number	Dates of Employment	Supervisor

Have you worked for another camp before? Yes No

If Yes, what Camp?
What was your position?

Have you ever been a camper at any camp? Yes No

If yes, was it Camp Hazen YMCA?	Yes No
If not Camp Hazen YMCA, where?

Personal Experience and Background Information

Please describe qualities about yourself that would make you an effective staff member at Camp Hazen YMCA. Give examples of how you have demonstrated these qualities.

How would you teach the character values of caring, honesty, respect, and responsibility?

Please describe all leadership and volunteer positions that you have held.

Please describe all experiences that you have had working with children. Please list the children's ages and your responsibilities.

Have you ever been convicted of a crime? Yes No

If yes, please explain:

I authorize Camp Hazen YMCA to complete the following:

Criminal Background Check

Sex Offender Reg Check

Personal and Professional References

Please list three references which Camp Hazen YMCA may contact. If possible, include one former employer and one individual who has seen you working with kids.

Name	Daytime Phone	Evening Phone	Relationship to You

Important Information

Mission Statement: "Camp Hazen YMCA is committed to helping youth develop valuable life skills through camping experiences that build healthy bodies, open minds and awakened spirits."

Physical Exam Required: State law and the American Camp Association accreditation requires that staff have a physical examination by a licensed Health Care Professional within two years of camp.

Personnel Policies: Camp Hazen YMCA is committed to providing a quality experience in a safe environment for the campers and staff. We ask staff to give up a great deal of privacy, the comforts of home, work long, demanding hours and adhere to policies which ensure an alcohol and tobacco free environment.

Staff Commitment: Working at Camp Hazen YMCA is an important responsibility. The rewards are found largely in the satisfaction of a job well done and in the personal growth and development of the campers and staff. Your submission of this form indicates your support of the Camp Hazen YMCA mission and your willingness to commit your best efforts and abilities towards achieving it.

Release, Personal Certification, and Digital Signature

I certify that the information provided on this application (and any resume submitted) is true and complete and that I have not knowingly withheld any information which might, if disclosed, affect my application unfavorably. I understand that any misrepresentation or omission of facts on this application will be cause for rejection of this application or dismissal after employment.
I authorize investigation of all statements herein and release Camp Hazen YMCA, its employees, agents or assigns, from liability in connection with the need to verify the truth of what I have said. I understand that Camp Hazen YMCA is entrusted with the care of children, and as such has an interest in making sure I am qualified and suitable for the position for which I am applying. To do this, Camp Hazen YMCA may wish to contact my former employers, educational instructors, and references as indicated in this application to inquire about my past records and characteristics as they may be related to my possible employment by the Camp. I authorize the Camp to speak to these individuals and organizations. Likewise, I authorize any former employer, educational instructor or reference contacted to furnish Camp Hazen YMCA with the needed information. Any information provided should be kept in strict confidence by the Camp.

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 a designated camp official.

By clicking 'Submit' here, I agree to the above statements. This stands as my signature to that effect.