New Staff Application Form Staff Application Name* First Last Permanent Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Email* Primary Phone Number*This number is my Cell Home Office Additional Phone NumberSocial Security Number*Are You:* 19 - 20 years old? 21 or older? Please indicate male, female, otherDate of Birth*Emergency Contact Name* First Last Emergency Contact Phone NumberDo you have a valid United States diver's license Yes No If yes, which State?Have you ever been convicted of child abuse or a sex related crime?* Yes No Have you ever been convicted of felony or misdemeanor?* Yes No If yes, please give details for each incident:CERTIFICATIONS*Do you currently hold any certifications (Lifeguard, Water Safety Instructor, CPR, First Aid, etc.? Please list all, along with expiration date. Please list last three places of employment including Dates of employment, Name of Employer, Job Title, Primary Job Responsibilities, Reason for Leaving, and Name and Number of Supervisor*Please list last three places of employment including Dates of employment, Name of Employer, Job Title, Primary Job Responsibilities, Reason for Leaving, and Name and Number of Supervisor*Please list last three places of employment including Dates of employment, Name of Employer, Job Title, Primary Job Responsibilities, Reason for Leaving, and Name and Number of Supervisor*Have you ever been fired from a job? If yes, please tell us what the job was and give the reason whyPlease list your highest level of education achieved:Please include name of school, dates attended, major/degree attained. Please give a detailed list of all of the experience that you have working with children.Camp Experience*Please list all relevant camp experience including name of camp, positions held, and dates employed. Let us know why you would like to participate in the Main Idea as a member of the staff. What will you contribute to the program? What do you hope to gain?*How did you hear about the Main Idea?Training Interest: Please check all that you are interested in. Lifeguard Canoe Instructor Water Safety Instructor High/Low Ropes Course Archery Pottery/kiln Sailing Please check off acitivity area that you feel confident in teaching or assisting in. Tennis Horse back riding Ropes course Sailing Archery Swimming Canoe Dance Drama Arts and Crafts Photography Nature/Environmental Science Yoga Landsports Step Office Work (Excel, Microsoft, Google Docs) Camp Scheduler (Scheduling 130 campers, 25 Junior Staff and 60 Staff) Hardy Girls Healthy Women, Summer Sisters Curriculum Camp babysitter (Babysitting the children of Camp Director and Senior Staff) Paddle boarding Of the activity areas that you checked of from above, please give detailed descriptions of your qualifications in each area.Please check off your current level of fitness ability. I could easily do a 5 mile mountain hike tomorrow. I could easily walk a mile to the corner store. I am on my feet all day at work but other than that I don't get a lot of other exercise. I'm not much for exercise. We require all staff to participate in at least one overnight camping trip in which you will be tent camping with a group of campers and 2 other staff members. Please check all that apply to you. I am an extremely competent tent camper. I know how to start a camp fire. I have used a coleman stove before. I have never slept in a tent before but I am looking forward to the new experience. I have never slept in a tent before and I don't think that I would be comfortable doing so. If you are hired as a bunk counselor, you will be living with a group of up to 12 campers and 2 to 3 other staff members. Please explain how you think you will do living with and caring for so many children.Our cabins do not have power (except in the attached bathrooms), please explain how you will handle living in this rustic setting.Please describe how you deal with stress, give at least 2 examples.Please describe how you deal with conflict between yourself and your co-workers.Please describe any experience you may have in leading groups, whether with groups of adults or children.We are able to accommodate a few select dietary needs. Please check any that apply. Vegan Vegetarian Gluten Free If you are a licensed driver and over 21, are you interested in taking our training to drive our 12/15 passenger vans. This is a great need at camp and we will be looking to hire a number of drivers. Yes, I am interested. No, I am not interested. I am interested but would feel more comfortable with a little bit of practice before taking the vans out with passengers. Unisex Adult T-shirt size Small Medium Large Extra Large 2 XL 3 XL 4 XL 5 XL