Staff Application

	Required Fields * PERSONAL HISTORY: NAME * SOCIAL SECURITY NUMBER * HOME PHONE * CELL PHONE E-MAIL ADDRESS * MAILING ADDRESS * CITY * STATE * ZIP CODE * CURRENT OCCUPATION AND YEARS TEACHING OR YEAR IN SCHOOL * How did you hear about us? * (i.e. friend, web, ad, etc.) POSITION DESIRED: (see cover letter for descriptions) * ACADEMIC INSTRUCTOR AQUATICS STAFF P.E. /FITNESS INSTRUCTOR COUNSELOR ACADEMIC INTERNSHIP ADMINISTRATIVE INTERNSHIP EDUCATIONAL HISTORY: NAME OF SCHOOLS (H.S., College, etc) DATES HIGHEST GRADE COMPLETED DEGREE * RELATED EMPLOYMENT EXPERIENCE (List most recent experience first) EMPLOYER'S NAME/ADDRESS PHONE NATURE OF WORK/RESPONSIBILITIES DATES * CRIMINAL HISTORY: In answering the following, you may omit any information or answer “no” with regard to any first convictions for Speeding, minor traffic violations, affray or disturbance of peace. Have you ever been convicted of a felony? * Yes No Have you been convicted of a misdemeanor within the last five years? * Yes No If yes, state the offense, date, and location. (A conviction record will not necessarily be cause for disqualification.) MISCELLANEOUS: Please complete the following questions in as much detail as possible. Please use additional pages as necessary. Do you hold a current drivers license? * Yes No If you don’t, please explain why: Why do you want to work at Fitness For Kids this summer? * What do you think you can contribute to the Fitness For Kids Summer Camp in the role in which you applied? * CERTIFICATIONS CERTIFICATION DATE Standard First Aid CPR Lifeguard Water Safety Instructor Instructional Teaching Other RECOMMENDATION INFORMATION: List 3 people NOT related to you whom can judge your qualifications for this position. If you have experience as a camp staff member, one reference should be from a camp director or camp administrator. Please have at least two of these people submit a completed Staff Leadership Reference Form. NAME * ADDRESS/PHONE * POSITION * I hereby affirm that the information provided on this application (and resume submitted) is true and complete. I understand that any false or misleading representations or omissions may disqualify me from further consideration for employment and may result in discharge if discovered at a later date. * I understand that as part of the application process the Fitness For Kids Summer Camp will perform a Criminal Offender Record Information Data Check (CORI) and a Sexual Offender Record Information Data Check (SORI) on all possible employees. * I hereby authorize the Fitness For Kids Summer Camp to investigate all information pertinent on my application in order to determine my qualifications for employment. I hereby authorize all persons and organizations having information relevant to my application to provide that information to the Fitness For Kids Summer Camp and I hereby agree to hold harmless the Fitness For Kids Summer Camp and all those providing information to it from any liability arising out of or as result of the provision or use of such information. I understand that any offer of employment may be rescinded if my references are inadequate or unacceptable to the Fitness For Kids Summer Camp. *