Staff Application

You may fill Rolling River Day Camp Staff Application by completing the form below.

Name:
Sex:
Date:
Email:
Permanent Address:
Street and No.:
City and Zip Code:
Telephone Number:
College or Local Address (if different):
Street and No.:
City and Zip Code:
Telephone Number:
 
Date of Birth: Month Day Year
Marital Status:
S.S.#:
Name/Age of Children:
Do you have drivers license?: Yes No
License #:
Plate #:
Type:
Driving Violation(s):
Will you have a car?: Yes No
Would you be a bus counselor?: Yes No
Would you be willing to drive a camp bus to transport campers?: Yes No
 
EDUCATION
  Name of School Major Date of Graduation Degree
High School:
College:
Other:
 
EMPLOYMENT (Work Experience)
Employer Address Dates Employed Position Salary
 
REFERENCES
 
Reference Name:
Relationship:
Street and No.:
City and Zip Code:
Telephone Number:
Email:
 
Reference Name:
Relationship:
Street and No.:
City and Zip Code:
Telephone Number:
Email:
 
Reference Name:
Relationship:
Street and No.:
City and Zip Code:
Telephone Number:
Email:
*Please send three (3) written recomendations with this application
 
Who do you know who works or has worked at Rolling River?
Check age level you prefer to work with Ages 3-5
Ages 6-9
Ages 10+
Older
 
What sports have you played on an organized level? Include high school and college as well as level of participation, awards, and honors:
Do you have any coaching or leadership eperience?: Yes No
If so, explain:
Please list below any special interests or talents:
 
Do you have any mental, emotional, or physical disability that would prevent you from participating fully in any camp activity?: Yes No
If so, please describe:
 
DO YOU HAVE (yes or no):
Water Safety Instructors (WSI) validated card: Yes No
Expiration Date:
Nassau Certification: Yes No
Class #:
Expiration Date:
CPR-BLS: Yes No
Expiration Date:
Lifeguard Traning (LGT): Yes No
Expiration Date:
First Aid Certification (Specify exactly):
Date Completed:
 
 
Please mark in the spaces below your proficiency in each activity.
LAND SPORTS:
Archery:
Badminton:
Basketball:
Bowling:
Football:
Golf:
Gymnastics:
Newcomb:
Rollerskating:
Soccer:
Softball:
Tennis:
Track & Field:
Volleyball:
Other:
CRAFTS:
Basketry:
Bead Work:
Ceramics:
Fabric Art:
Jewelry Making:
Leather Work:
Macrame:
Metal Craft:
Model Bldg.:
Puppetry:
Sewing:
Woodworking:
Other:
FINE ARTS:
Painting:
Origami:
Sketching:
Other:
MUSIC:
Vocal:
Instrumental:
Other:
CAMP CRAFT:
Nature Study:
Pioneering:
Fishing:
Gardening:
Other:
BOATING:
Canoe:
Rowboat:
Motorboat:
Kayak:
Paddleboat:
Other:
DANCE (Specify Style):
DRAMATICS (Specify):
TWIRLING:
CHEERLEADING:
NEWSPAPER:
COMPUTER:
 
*Please note: This application must be completed in full in order to be processed and reviewed*
 
Initialize:
 

 

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