Fun, Family and Friends Forever - What Blue Rill is All About

Online Staff Application

First and Last Name:	*
Email:	*
Cell Phone:	*
Home Address:	*
Home City:	*
Home State:	*
Home Zip:	*
Home Phone:	*
Gender	Male Female
Are you over 18 years of age? If not, how old are you?	*

Did someone recommend Blue Rill to you?	Yes No
If so, who?
Are you a former Blue Rill Camper?	Yes No
I am applying for:	Junior Group Counselor (currently in 10th or 11th grade) Group Counselor (currently high school senior or older) Craft, Sport or Specialty Staff Lifeguard/Swim Instructor (currently 10th grade or older) Other:
I am interested in being a bus counselor:	Yes No
Are you available for the full eight weeks of camp (Monday, June 25th through Friday, August 17th)?	Yes No
If not, please explain:

Educational Background

High School Education

Current Year:	Freshman Sophomore Junior Senior Graduate
Name Of School:
(Expected) Graduation Date:

College Education

Current Year:	Freshman Sophomore Junior Senior Graduate
Name Of School:
(Expected) Graduation Date:
Major & Minor:

Graduate School

Current Year:
(Expected) Graduation Date:
Major & Minor:

Camp Experience

Camp:
Summers Attended as Camper:
Summers Worked:
Position:
Director:
Phone:
Camp:
Summers Attended as Camper:
Summers Worked:
Position:
Director:
Phone:

Other Employment

(Provide a full record of all employment and explain any gaps in employment in the space provided below.)

Employer:
Dates Worked:
Phone:
Nature of Work:
Supervisor:
Reason For Leaving:

Employer:
Dates Worked:
Phone:
Nature of Work:
Supervisor:
Reason For Leaving:
Please explain gaps in employment (if applicable)

Recommendations

This section must be completed in order for Blue Rill to review your application. Once contacted for an interview, you will be required to submit three written recommendations to Blue Rill. All recommendations must be written by an adult (21 years or older) and may not be from anyone related to you. The reference form is available on our website. At least one of your references must be child-related, from an individual who has seen you working with children i.e. a parent from a family you have baby-sat for, a sports coach or teacher who has seen you working with younger children etc. The other references may be from adults who have knowledge of your character, experience and abilities i.e. teacher, guidance counselor, employer, clergy etc.

Child-Related Reference

Name:	*
Email:	*
Address:	*
City:	*
State:	*
Zip Code:	*
Phone:	*
How does this person know you?	*

General References

Name:	*
Email:	*
Address:	*
City:	*
State:	*
Zip Code:	*
Phone:	*
How does this person know you?	*

Name:	*
Email:	*
Address:	*
City:	*
State:	*
Zip Code:	*
Phone:	*
How does this person know you?	*

Certifications

Do you hold any of the following certifications?
Lifeguard Training:	Yes No
Issuing Agency:
Date Completed (MM/DD/YY):
Expiration Date (MM/DD/YY):
Water Safety Instructor:	Yes No
Issuing Agency:
Date Completed (MM/DD/YY):
Expiration Date (MM/DD/YY):
CPR:	Yes No
Issuing Agency:
Date Completed (MM/DD/YY):
Expiration Date (MM/DD/YY):
First Aid:	Yes No
Issuing Agency:
Date Completed (MM/DD/YY):
Expiration Date (MM/DD/YY):
Epi-Pen Certification:	Yes No
Issuing Agency:
Date Completed (MM/DD/YY):
Expiration Date (MM/DD/YY):
Other Certification:	No Yes:
Issuing Agency:
Date Completed (MM/DD/YY):
Expiration Date (MM/DD/YY):

Special Interests or Skills

Do you have special talents or skills in the following?
Sports: Yes No	Explain talent or skill:
Crafts: Yes No	Explain talent or skill:
Nature: Yes No	Explain talent or skill:
Rock Climbing and Ropes Course: Yes No	Explain talent or skill:
Ceramics: Yes No	Explain talent or skill:
Archery: Yes No	Explain talent or skill:
Theater Arts: Yes No	Explain talent or skill:
Other:	Explain talent or skill:
Other:	Explain talent or skill:
What contributions do you think you can make at camp?
What contributions do you think a well run camp can make to children?
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) to which you are applying.

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 or in other documents completed by the applicant will result in dismissal, regardless of the time of discovery by the camp. I give Blue Rill Day Camp authorization to do a full background search.

Yes No

For print out purposes please sign and date.

Signature:________________ Date:_________