Coleman Country Day Camp Staff Application

P.O. Box 34, Merrick, NY 11566
Phone: 516-620-4300 • Fax: 516-620-4329
Email: jobs@ColemanCountry.com

Online Staff Application

Please read the application handbook. Submit two letters of reference and/or Coleman Country Day Camp reference forms with this application. References should be provided by non-family members who can attest to your qualifications as an adult able to work with children and with other camp staff.

First Name: Middle Name: Last Name: Male Female

Mailing Address:
Street 1: Street 2:
City: State: Zip code: Country:

Phone: Additional Phone: Date of Change for Mailing Address (if applicable):

E-Mail Address:

Social Security No. Driver's License No. Type: State:

How old will you be on the first day of camp? (optional): Date of Birth (optional):
(Listing your age helps us determine the positions available to you at Coleman Country Day Camp.)

I am applying for the following position(s) (check all that apply):

Coleman Country Day Camp

Group Counselor Specialty Counselor/Instructor Maintenance
Counselor-In-Training (for applicants entering 9th or 10th grade in September)
Seasonal Office Staff Year-Round Office Staff Other

Education level: (Check all that apply):

I am a college graduate:	College(s)	Degree(s)	Grad. Year
I am a college student:	College	Major	Year
I attend(ed) high school:	School	Number of Years
I am a middle school student:	School	Grade

If applicable, please list any of your children who you plan to have attend Coleman Country Day Camp this summer:

1.	Name:	Age:
2.	Name:	Age:
3.	Name:	Age:

Please list the names of any former or current Coleman Country Day Camp staff you know, and indicate any who could serve as a reference:

Tell us how you heard about Coleman Country Day Camp:

Tell us why you would like to work at camp:

Tell us why you have chosen to apply to our camp in particular:

Please list any previous experiences you've had as a camper:

1:	Camp Name:	Years:	Director:
2:	Camp Name:	Years:	Director:
3:	Camp Name:	Years:	Director:

Please list any previous experiences you've had as a camp counselor:

1:	Camp Name:	Years:	Director:
	Position Held:	Salary (Optional):

2:	Camp Name:	Years:	Director:
	Position Held:	Salary (Optional):

3:	Camp Name:	Years:	Director:
	Position Held:	Salary (Optional):

Please list your most recent employment:

1:	Employer: Dates: Supervisor:
	Phone Number: Position Held: Salary (Optional):
	May we contact this employer? Yes. No. If not, why?

2:	Employer: Dates: Supervisor:
	Phone Number: Position Held: Salary (Optional):
	May we contact this employer? Yes. No. If not, why?

3:	Employer: Dates: Supervisor:
	Phone Number: Position Held: Salary (Optional):
	May we contact this employer? Yes. No. If not, why?

Which age group(s) do you feel you are best suited to work with?:

3-5 years old 6-8 years old 9-11 years old 12-13 years old 14+ years old

Why do you feel you are best suited to work with the age group(s) you selected?

Please list the names and expiration dates of any professional certifications you currently hold (for example: CPR, Water Safety Instructor, Certified Lifeguard, First Aid, Wilderness First Response, etc.):

1:	Certification:	Certified Since:	Expires:
2:	Certification:	Certified Since:	Expires:
3:	Certification:	Certified Since:	Expires:

Please provide the dates you are available to work this summer:

Areas of Interest - Please Indicate Areas in Which You Have 1. Interest 2. Experience/Training 3. Instructional Ability

CREATIVE ARTS
Ceramics/Pottery	1 2 3
Crafts	1 2 3
Drawing	1 2 3
Home Cooking	1 2 3
Journalism	1 2 3
Leatherworking	1 2 3
Natural Crafts	1 2 3
Painting	1 2 3
Photography	1 2 3
Sculpture	1 2 3
Video	1 2 3
Woodworking	1 2 3

PERFORMING ARTS
Acting	1 2 3
Comedy (Stand-Up)	1 2 3
Costume Design	1 2 3
Creative/Script Writing	1 2 3
Dance	1 2 3
Directing	1 2 3
Improvisational Acting	1 2 3
Leading Songs	1 2 3
Lighting	1 2 3
Playing Instrument	1 2 3
Sound	1 2 3
Stage Management	1 2 3
Voice Instruction	1 2 3

SPORTS
American Football	1 2 3
Archery	1 2 3
Basketball	1 2 3
Golf	1 2 3
Gymnastics	1 2 3
Hockey	1 2 3
Lacrosse	1 2 3
Martial Arts	1 2 3
Soccer	1 2 3
Softball/Baseball	1 2 3
Tennis	1 2 3
Track & Field	1 2 3
Volleyball	1 2 3

AQUATICS
Canoeing/Kayaking	1 2 3
Fishing	1 2 3
Swimming	1 2 3
Water Aerobics	1 2 3
Water Polo	1 2 3

NATURE & ECOLOGY
Animal Care	1 2 3
Astronomy	1 2 3
Botany	1 2 3
Environmental Education	1 2 3
Geology	1 2 3

CAMPING SKILLS
Backpacking	1 2 3
Orienteering	1 2 3
Outdoor Cooking	1 2 3
Primitive Camping	1 2 3

ADVENTURE
Rappelling	1 2 3
Rock Climbing	1 2 3
Ropes Course (high)	1 2 3
Team Initiative (low)	1 2 3

GROUNDSKEEPING
Construction	1 2
Landscaping	1 2
Maintenance	1 2

SUPPORT
Housekeeping	1 2
Laundering	1 2
Live Sound, A/V, etc.	1 2
Office	1 2
Parent Relationships	1 2

Choose three areas from above that you would most like to teach.		Tell us why you feel you are qualified to teach the indicated area of interest.
1.		1.
2.		2.
3.		3.

If you have a degree or certification in one or more of the following areas of specialty, mark the corresponding box.

Registered Nurse Emergency Medical K-12 Academics

List any additional experience/skills you have that may apply to your position as a staff member:

Tell us about a favorite teacher, coach, or mentor and why he or she made an impact on you:

Please describe your most recent experience working with children:

Please answer the following questions. If you answer "Yes" to any of these questions, please explain in the space provided below.

1. Has your name ever been placed on the Central Registry of child abuse?	Yes No
2. Have you ever been convicted of a felony?	Yes No
3. Have you ever been convicted of driving under the influence of alcohol or a controlled substance?	Yes No

In order to safeguard the well-being of our campers, Coleman Country Day Camp will investigate the accuracy of all information provided during the application process. This investigation may include, but is not limited to, reference checks with past employers, the military, educational institutions, volunteer organizations, civic groups, and law enforcement agencies. As an applicant submitting this form, you consent to a professionally-conducted background check. Please note that Coleman Country Day Camp employees are required to cooperate with random substance abuse testing.

Important Information for Coleman Country Day Camp Staff

Smoking is not permitted on camp property or during any off-site camp activities. The illegal use of any controlled substance is absolutely prohibited while you are a staff member with Coleman Country Day Camp. No alcoholic beverages may be brought onto camp property, and no one is to return to camp under the influence.

It is very important that you read and understand the Coleman Country Day Camp Staff Application Handbook. As a member of our staff, you will be required to adhere to these policies and guidelines as well as those described in our staff manual and as conveyed during training. The Application Handbook will give you a basic understanding of the requirements of our camp jobs so you can ensure that a position with Coleman Country Day Camp is appropriate for you.

Camp work is physically, mentally, and emotionally demanding, requires long hours, mobility over a variety of terrain, and involves adherence to camp policies that may be limiting (limited time off, lack of privacy, no smoking, etc.).

Is there anything that would prohibit you from complying with this lifestyle and these policies? Yes No

If you checked yes or require any special accommodations to perform your duties, please explain:

To complete your submission please enter 28472 in the following field:

By submitting this form, I certify that all information I provided on this application and all other information provided as part of the application and interview process is correct and true.

jobs@ColemanCountry.com