SIDC

Employment Application

2010

Last Name ______________________________ First ________________________

Today’s Date ____________ M/F ____

Phone # __________________ Cell # ________________ Social Security __________________

Home Address ____________________________________ City ______________________ State __________ Zip ________

Email Address _________________________________________

Birth date ______ /______ / ______ Age ______ Are you a U.S. Citizen? __________

Position Desired (Be Specific: Specialty, Lifeguard, Counselor) _________________

Are you a Certified Teacher?______ If yes, were are you positioned____________ Subject__________

If hired, is this your only job? ______________ Days & hours of other employment: ________

If College Student, Name of School_________________ Year______________

Name of School (if graduated): __________________________ Degree Earned: __________ Years Attended: ____________

Do you have transportation? __ yes ___ no Do you drive? ___ yes ___ no

Swimming Ability: ___Fair ____Good ____Excellent

Have you ever worked for a camp? If yes, Name of Camp: ____________________________

Duties: __________________________________ Phone # __________________

Dates Employed ______________________

Have you attended camp? If yes, Name of Camp: _____________________

Dates Attended __________________

Please list last 3 employers: (If applicable)

Employer Dates Employed Position Supervisor Telephone #

1.____________________________________________________________________________

2.____________________________________________________________________________

3.____________________________________________________________________________

List 3 references (non-relatives) who have knowledge of your ability & character:

Name Relationship Job Title Telephone #

____________________________________________________________
____________________________________________________________
____________________________________________________________

Have you ever been convicted of any crime including child abuse or sexual abuse?

If yes, please explain: ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Why do you think you would be an asset to our camp? ______________________________________________________________________________
______________________________________________________________________________

______________________________________________________________________________

How did you hear of Staten Island Day Camp? ______________________________________________________________

To be completed later with a senior staff representative of the SIDC

Note: The SIDC is located on the grounds of the College of Staten Island. The vast inside areas used by the camp are air-conditioned. In addition, the SIDC does not schedule any off site trips or entertainment. All entertainment and special activities/events are held on site.

****I attest that all information on this applicant is truthful and accurate.

Signature _______________________________ Date_________________________

Group _______________________________