Summer Camp Staff Application

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Name *

First

Last

Current Address *

Address Line 1

Address Line 2

City

State

Zip Code

Permanent Address (if different from current address)

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Will summer or

Age as of June 13 *

14
15
16-17
18-20
over 21

Driver's License Number/State

Parent/Guardian Name*

Emergency Contact Name *

Emergency Contact Number *

Is there anything that the Mecklenburg County Council should know that makes you unsuitable to work with children?

Is there any reason you would be unable to drive a vehicle?

T-Shirt size

Small
Medium
Large
XL
XXL
XXXL

14 years old First Choice

15 years old and older First Choice *

15 years old and older Second Choice *

15 years old and older Third Choice *

I would like to serve as an area director *

Dates available for employment (BE SPECIFIC) *

To *

List any days off requested during this time?

YOUTH ORGANIZATION EXPERIENCE

Are you currently registered in Scouts BSA?

Scouting America ID Number

Unit No.

Council/Organization

Number years tenure as a youth

Number years tenure as an adult

Offices held

Scouts BSA rank

Other achievements

Have you ever served on a camp staff?

When and where?

Describe leadership experience

Check the following complete and enter expiration dates

SAFE Guarding Youth
Weather Hazards

SAFE Guarding Youth expiration date

Weather Hazards Training expires

Check any of the following certifications you hold and enter their expiration date

First Aid
Lifeguard
Scouting America National Camp School
CPR
Shooting Sports
Ropes Course (COPE)

First Aid Certification expires

Scouting America National Camp School Certification expires

CPR Certification expires

Shooting Sports Certification expires

Ropes Course (COPE) Certification expires

Hobbies, skills and special interests

Scouting America summer camps you've attended

Strongest Scout skills

Weakest Scout skills

EDUCATIONAL BACKGROUND

High school

Years attended

Graduation date

College name and location

Years attended

Graduation date

Other

Scholastic honors

Sports

Activities

Offices held

Languages spoken other than English

Final grade point average

EMPLOYMENT

Present or most recent employer

May we contact

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Start date

End date

Job title

Supervisor name

Description of duties (include significant responsibilities, accomplishments, and contributions)

Reason for leaving

Have you ever been discharged or asked to resign from any job?

If yes, explain below

Will you give Mecklenburg County Council permission to do a background check?

Additional employers name and contact information

Phone

Additional employers name and contact information

Phone

Additional employers name and contact information

Phone

REFERENCES

Provide names and addresses of three persons (not relatives) who have knowledge of your character, experience and ability.

Name *

First

Last

Email *

Phone *

Name *

First

Last

Email *

Phone *

Name *

First

Last

Email *

Phone *

I hereby make application for employment, and in accordance with the principles of the organization, subscribe to the Scout Oath or Promise, Law, and Declaration of Religious Principle. I agree to be loyal to and cooperate fully with all the Scouting America policies, program, and management including those described in this application. I further agree to submit a completed Health and Medical Record upon my arrival, if selected. I understand that a personal interview may be required before employment will be granted. I authorize investigation of all statement contained in this application for employment as may be necessary in arriving at an employment decision, including but not limited to any investigation of statements made regarding any previous criminal record. I authorize all my previous employers, schools, and all other references to furnish the information requested. I hereby declare that the information provided by me in this application for employment is accurate and complete to the best of my knowledge. I understand that any falsification of misrepresentation in this application is cause for discharge and denial of worker's compensation benefits. By clicking "Submit", I acknowledge that I am the person named on this application. If under 18 years of age, I acknowledge that I have my parent's or legal guardian's permission to make this application for employment. STOP.THINK.CLICK. External email – Use caution before clicking links, opening attachments, or sharing sensitive data. Seek guidance from your supervisor if unsure.