Arlene Streisand's
Summer Camp Services
P.O. Box 196
Jericho, NY 11753
1-800-443-6428 • • • 516-433-8033
Fax: 516-933-7949

PRINT THIS APPLICATION FIRST!
ANSWER ALL QUESTIONS and fax to: 516-933-7949

APPLICATION CHECKLIST

Please make sure you complete the following:

• Answer ALL questions on the application

• Attach a recent photo

• Enclose (if available) reference forms or letters of reference

• Include copies of credentials such as WSI, LGT, LGIT, Coaching Licenses, etc.


APPLICATION

Name:__________________________________Social Security #_____________________

Present Mailing Address:_____________________________Telephone:________________

City______________State_________Zip Code______________E-Mail________________

Permanent Address:_________________________________Telephone:________________

City______________State_________Zip Code______________E-Mail________________

Height:____________Weight:_______Date of Birth:___________Sex (M or F)___________

Age as of next July 1st:_____________

Do you smoke?
___Yes ___No
Are you married?
___Yes ___No
Do you have any children? ___Yes ___No
If yes, please explain. ___________________________________________________
___________________________________________________
___________________________________________________
Have you ever been arrested or convicted of a crime? ___Yes ___No
If yes, please explain. ___________________________________________________
___________________________________________________
___________________________________________________

 

EDUCATION
College Major Subjects Years Degree Granted
       
       

PAST EMPLOYMENT: List previous two summers or years
Dates Employer Phone Number Nature of Work
       
       

CAMP EXPERIENCE
Dates Camp Director Location & Phone Dates
         
         

Are you available from approximately June 15 to August 18?__________________________

Salary request:_________________

Age group you prefer for your own cabin assignment:_________________________________

What type of position do you want at camp? If specialties, list in order of preference:_________

_________________________________________________________________________

 


In the following list, put numeral "1" before those activities you can organize and teach as an expert, "2" for those activities in which you can assist in teaching, and "3" for those which are just your hobby. (Only indicate those areas which apply to you).
Arts & Crafts Dance Nature   Registered Nurse
__Basketry __Acrobatic __Animals __Riflery __Pediatrics
__Batik __Ballet __Astronomy __NRA Instructor __R.N. (date, state)
__Candlemaking __Tap __Birds __Skating Miscellaneous
__Ceramics __Folk __Conservation __Soccer __Audio/Visual Equip
__Copper Enamel __Jazz __Farming __Softball __Bike Repair
__Jewelry __Modern __Flowers __Street Hockey __Campfire Programs
__Leather Work __Aerobics __Forestry __Tennis __Evening Programs
__Metal Work Dramatics __Gardening __Track & Field __Indian Lore
__Mosiac Tile __Creative __Insects __Trampoline __Language
__Nature Crafts __Play Directing __Rocks & Minerals __Volleyball __Newspaper
__Painting __Skits and Stunts __Trees & Shrubs __Weight Training __Photography
__Pottery __Sound/Light Board __Weather __Free Weights __Darkroom Instruction
__Silkscreen __Set Design Sports __Universal __Radio/Electronic
__Sculpture __Costuming __Archery __Wrestling __Storytelling
__Silver Work Gymnastics __Badmitton __Roller Blading __Computer Science
__Sketching __Beam __Baseball __Roller Hockey __Bridge
__Stained Glass __Bars __Basketball Waterfront Activities __Juggling
__Weaving __Floor __Bicycling __Canoeing __Circus
__Wood Carving __Vault __Boxing __Diving __Secreterial
__Wood Working __Advanced Skills __Fencing __Kayaking __Security Guard
__Rocketry Kitchen/Lanudry __Field Hockey __Lifesaving __Nanny
__Cartooning __Food Preparation __Fishing __Motorboat Driving Equestrian
Adventure __Cleanup/Maintenance __Golf __Rowing __English
__Backpacking __Food Service __Informat Games __Sailing __Western
__Mountain Biking __Chef __Jogging __Scuba  
__Camping Skills __Steward __Karate __Swimming  
__Hiking Music __Lacrosse __Water Polo  
__Orienteering __Bugle   __Water Skiing  
__Outdoor Cooking __Drums   __Windsurfing  
__Overnight Camping __Guitar      
__Rock Climbing __Instrument (List)      
__Ropes Course __Song Leader      
  __Piano Accompanist      

Do you currently hold any American Red Cross instructor certificates? If so, please list expiration dates:____________________________________________________________________

WSI___________CPR___________EMT___________First Aid Responder_____________

Canoeing__________First Aid__________Certified Rescue Aide__________Other________

Sailing____________Life Guard_________Life Guard Instruction/Trainer________________

Any physical defects or diseases affecting your ability to perform your job:_________________

_________________________________________________________________________

If you have a friend or a relative interested in camp work, please state their name, address and

telephone number: Name:___________________________________________________

Address:___________________________________________Phone:________________

Do you own a car?____________Would you drive to camp?_________________________

Would you be willing to take passengers?________________________________________


PLEASE COMPLETE (attach additional sheets if necessary)
You MUST answer the questions below:

1) Outline your training and/or experience in the activity areas you wish to work. Include any other biographical data such as family, travels, camping experiences, etc., which might have a bearing in this application. Be sure to include any competitive or varsity experiences:

 

 

2) Why do you want to be a camp counselor? What contribution do you think you can make at camp? What qualities or characteristics do you feel you have which will enable you to be an effective counselor? Do you have any leadership skills or special abilities?

 

 

3) Please indicate first and second choice:

Circle Age Group of Campers you prefer for cabin duty: 5-7 • 7-9 •9-11 • 13-15 • 15 & over
• Flexible

Circle Age Group you are best equipped to teach: 5-7 • 7-9 • 9-11 • 13-15 • 15 & over
• Flexible

Please make a copy of your entire application and keep it for your records.

Signature:_____________________________Date:_____________________________

Important next step!!!!
CLICK HERE to get reference form!!!


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