Girl Scouts of Central Indiana Camp Staff Application 7201 Girl Scout Lane Indianapolis, IN 46214 (317) 924-6827 / Fax: (317) 931-3348 Web Address: www.girlscoutsindiana.org Instructions Please print or type clearly. Mail or fax to Girl Scouts of Central Indiana to the attention of the Camp Department. Personal information Name Date E-mail address Present address Permanent address Present phone Cell phone Age (Some positions have minimum age requirements.) q Under 18 q 18-20 q 21-24 q 25-35 q 35 or over Permanent phone Best day and time to reach you by telephone Dates available Have you ever been convicted of a crime, other than traffic violations? q Yes q No If yes, please state offense, date and location. A conviction record will not necessarily be cause for disqualification. to
Position desired Please indicate camp along with first and second position preference. Camp Dellwood (day camp) Indianapolis, IN Tag unit supervisor Tag unit counselor supervisor Kitchen manager Cook Day Camp Aide instructor Program Manager Math and Science Center STEM Van Driver STEM Van Assistant Camp Gallahue (resident camp) Mogantown, IN Waterfront supervisor Kitchen supervisor Cook Horse program supervisor Horse program staff Horse barn manager Business/equipment manager Program director Arts and crafts director Sports/archery instructor Nature Camp Na Wa Kwa (day/resident) Poland, IN Waterfront director supervisor Kitchen manager/cook Climbing Wall supervisor Climbing Wall assistant Camp Sycamore Valley (day/resident) Lafayette, IN Kitchen manager/cook Program Manager (archery, lifeguard, climbing wall, crafts) S.T.E.M. Specialty Camp (resident) location varies each week Counselor
Camp Staff Application Page 2 Education Name of schools (high school, college, graduate school), dates attended and degrees or credits. List major area of study and specific courses related to position desired. Experience as a Girl Scout (previous experience not required) Indicate years of participation. Girl Adult Experience with children s groups Indicate age groups in which you have experience. q 6-8 q 9-11 q 12-14 q 15-17 Please list in what capacity you obtained this experience. Training and skills Courses taken in training and leadership Training Agency Place Dates Current certification Proof of certification is required. Please attach photocopy of certification. Certification Organization Exp. Certification Organization Exp. (Red Cross, etc. ) date (Red Cross, etc. ) date ing First aid Water safety instructor Sailing instructor Canoeing instructor CPR Registered nurse/emergency medical technician Licensed driver Boating instructor Horseback riding instructor
Camp Staff Application Page 3 Employment experience List most recent employment first. Address must be complete. Employer s name, address and phone Position/major responsibilities Dates employed To Reason for leaving Supervisor s name Employer s name, address and phone. Position/major responsibilities Dates employed To Reason for leaving Supervisor s name Experience as a camp staff member List most recent experience first. Address must be complete. Camp name and address Position Year Contact information Supervisor References List three people, not related to you, who can evaluate your qualifications for this position. If you have previous experience as a camp staff member, one reference should be from a camp director or administrator. Name Address and phone E-mail address Position I understand that successful completion of a physical examination is a condition of employment for resident camp staff only. I certify that all information provided on this application is true and complete. I understand that falsification of any information may be considered justification for dismissal if discovered at a later date. If I am employed, I agree to comply with and be bound by the safety and health rules and regulations, and rules of conduct established by Girl Scouts of Central Indiana. I give Girl Scouts of Central Indiana the right to investigate any and all statements made in this application for the purpose of employment and retention of employment. This investigation may include, but is not limited to, credit reports, criminal conviction records, motor vehicle driving records and previous employment history. Further, I hereby release from liability and hold harmless this employer and its representatives, all persons and organizations/companies for furnishing such information. If requested, I agree to a drug testing prior and during employment or for post accident occurrences. The employer is an equal opportunity employer. Girl Scouts of Central Indiana does not discriminate in employment and no questions on this application are used for the purpose of limiting or excusing any applicant s consideration for employment on a basis prohibited by local, state, or federal law. Signature Date
Camp Staff Application Page 4 Questions Please answer the following questions. Why are you interested in working at a Girl Scout Camp? Please explain your qualifications for the job. What personal qualities do you have that make you a positive role model for girls and young women? Describe some experiences you have had working with children. The mission of Girl Scouts of Central Indiana is to build girls of courage, confidence, and character, who make the world a better place. How can camp staff work toward this mission? Describe an occasion when you worked with people different than yourself. What was the outcome?