Name*

Social Security #*

Permanent Address*

Phone*

Fax

E-mail*

Term Address

Phone

Fax

Term Address is Good Through

Best Time/Day to Call

Present Occupation

Date of Birth

EDUCATION

College

Major Subject

Present Status (check one) Freshman  Sophomore  Junior  Senior  Graduate

Year Degree Granted

WORK EXPERIENCE: List current and past two employers, dates, address, phone, type of work.

CAMP EXPERIENCE: List whether camper or staff, name of camp, director, address, and dates.

For the following, place a "1" before those activities which you can teach with skill as an expert, a "2" before those you can do or play well, and a "3" before those you can assist in teaching:

ARTS & CRAFTS

Other areas of arts expertise:

PERFORMING ARTS:

Other areas of performance expertise:

LANDSPORTS:

Other areas of sports expertise:

WATERSPORTS:

Other areas of waterfront expertise:

OUTDOOR ADVENTURE:

Other areas of outdoor expertise:

MISCELLANEOUS:

Other areas of expertise:

MEDICAL:

HORSEBACK RIDING:

Which of the above activities would you like to teach?

1st Choice*

2nd Choice*

Dates available to work: From to

* REFERENCES: Please list three people who have knowledge of your character, work experience and ability, and who are not relatives or personal friends. Please give a reference form to each person you list, accompanied by a stamped envelope addressed to Camp Tapawingo, P.O. Box 248, Maplewood, NJ 07040 or advise to e-mail to JD@camptapawingo.com.

* BIOGRAPHY: Write a brief biographical sketch, including specialized training in camping and experience or training in other fields which might have a bearing on the position(s) for which you are applying.

CERTIFICATIONS/LICENSE

I am currently certified or will be by June 1 (complete appropriate lines)

Certification cards/license documents will be requested at camp for purposes of copying and to have on file during the camp season.

TRIP APPLICANTS ONLY: List your experiences for Trips (backpacking-canoe)

Do you Drive?* Yes No

License Number

State---AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming

Have you had any accidents or violations within the last 3 years?* Yes No

If yes, explain:

Where did you learn about Tapawingo?

Have you ever been convicted of an offense involving a child or sexual abuse?* Yes No

I authorize investigation of all statements herein and release the camp and all others from liability in connection with same. I understand that, if employed, I will be an at-will employee and that any agreement to the contrary must be in writing and signed by the director of the camp. I also understand that untrue, misleading, or omitted information herein may result in dismissal, regardless of the time of discovery by the camp.

Security Code: