Employment Application
Name
Email
Date of Birth
Age as of July 1
Home Address
Town
State
Zip
Phone
Social Security #
Present School
Overall School Grade Average
Present Grade
What have you done over the past summers
Summer 2009
Summer 2008
Please check the activities you can lead
Dramatics
Video
Newspaper
Tennis
Arts & Crafts
Gymnastics
Cooking
Swim
Fishing
Baseball
Golf
Basketball
Photography
Ceramics
Pottery
Soccer
Nature
Hockey
Rope Course
Dance
Lacrosse
Volleyball
Boating
Computers
Radio
Cheerleading
Other:
Activities you feel you can specialize in:
Were you a Jeff Lake camper?
Yes
No
Can you read music?
Yes
No
Age group preferred:
First
Second
Third
Ages 3-5
Ages 6-9
Ages 10-12
Ages 13-14
Swimming ability
Poor
Average
Good
Certifications
ALS
WSI
Have you ever been convicted of a felony (we will verify)?
Yes
No
Have you ever been charged with a crime involving children?
Yes
No
Please be aware that Jeff Lake Camp does a criminal background check on all employees
over the age of 18.
Reference
Name
Place
Address
Phone
I was recommended by
Friends who work at JLC
Please write anything you feel might encourage a favorable consideration of your application:
