Hiram House Staff Application

Age:

over 17 over 21

Last Name:

Hiram House Camp is an equal opportunity employer and does not discriminate because of race, sex, religion, age, marital status, national origin, or disability.

The Hiram House
33775 Hiram Trail * Moreland Hills, Ohio 44022
(216) 831-5045 * www.hiramhousecamp.org

First Name:

Middle Initial:

City:

State:

Zip:

Phone:

Social Security Number:

City:

State:

Zip:

Phone:

Email Address:

To which address should mail be sent?:

Permanent Current/School

Please explain any difficulty you may have in performing any of the essential functions of the job.

Have you previously applied for employment at Hiram House Camp?:

Yes No

If yes, when?:

Have you ever been convicted of a felony?:

Yes No

If yes, please describe:

Dates you are available to work:

From to

All staff must be able to work the entire summer camp season. Are there any days you will be absolutely unable to work? If so, please list any dates and reasons.

Resident Counselor	Unit Leader
Day Camp Counselor	Lifeguard
Jr. Day Camp Counselor	Nurse
Assistant Nurse	Director/Assistant Director

Specialist Positions:

(check all that apply)

Archery	Boating
Low Ropes	Outdoor Skills
Climbing Wall	Nature
Arts & Crafts	Western Horsemanship
Heifer Project	Performing Arts

A.R.C.W.S.I or equivalent	E.M.T.
Advanced Lifesaving	A.R.C. First Aid
Life Guarding	A.R.C. First Aid Instructor
A.R.C. Smallcraft Instructor	A.C.A.O.L.S. Instructor
CPR (child)	CPR (adult)
A.A.A. Instructor	Challenge Course Instructor
Other (Please list)

List the last two schools you have attended or are attending.

School (city, state)	Major Subjects	Degree Granted	Years Attended

Please list any achievements or recognitions you received during your academic career:

Please list any extracurricular activities you have been involved in and any specialized courses you have taken that would be of benefit to camp:

How do you feel your education has prepared you for working with children in a summer camp setting?

Why do you want to work with and care for children?

List camps you have attended as a camper or staff member.

Dates	Camp (City, State)	Director	Camper or Staff (position)?

List activities in the following areas that you have had experience in or that you feel you can teach.

Outdoor Skills:

Creative Arts:

Sports/Waterfront:

Natural Sciences:

Other:

List all present and past employment, beginning with the most recent.

(1) Name and Address of Business:

	Phone:

Dates of Employment:

	Job Description:		Salary:

Reason for Leaving:

	Name of Supervisor:

(2) Name and Address of Business:

	Phone:

Dates of Employment:

	Job Description:		Salary:

Reason for Leaving:

	Name of Supervisor:

(3) Name and Address of Business:

	Phone:

Dates of Employment:

	Job Description:		Salary:

Reason for Leaving:

	Name of Supervisor:

How has your work history prepared you for a job at summer camp and for dealing with both campers and other staff members?

Why should Hiram House choose you as a staff member?

How did you hear about Hiram House Camp?

Other than through school and employment how are you involved with children?

How do your personal values and lifestyles coincide with the camp�s philosophy and objectives?

List four personal, professional references who you will ask to fill out a form regarding your
work experience, character, and ability. Do not include relatives, fellow students or friends of the family.

(1) Name, Company and Position:

	Home Phone:		Work Phone:

Address:

	City:		State:		Zip:

(2) Name, Company and Position:

	Home Phone:		Work Phone:

Address:

	City:		State:		Zip:

(3) Name, Company and Position:

	Home Phone:		Work Phone:

Address:

	City:		State:		Zip:

(4) Name, Company and Position:

	Home Phone:		Work Phone:

Address:

	City:		State:		Zip:

I authorize investigation of all statements contained within this application 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, that the employee or employer is free to terminate the agreement at any time and for any or no reason, 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 time of discovery by the camp. I further give permission, in accordance with the laws of the State of Ohio, to be fingerprinted and undergo a criminal background investigation, and to undergo any legal drug or physical tests required by the employer.

I have read, understand and agree to follow all customs and policies as a member of The Hiram House staff.