Name:

Position Applying for:
- please only fill one

Day Camp

Resident Camp

Availabilty:

Are you over the age of 18 and will you have completed
1 year of College by June 2008?

Are you-

Male

Female

Current Address (Please also state how long you will be at this address):

Permanent Address:

Please enter the email you would like us to send information to.

Phone:

How did you hear about us?

Camp Channel

Google Search

Friend / Other

EDUCATION: List all high schools and colleges. In college, give majors and minors, along with number of years completed.

Please check any certifications you currently hold.

Did you ever attend camps as a camper? If so, where and when?

Please tell us about any honors or awards you have achieved:

Please list any job related organizations, clubs, or other associations you belong to:

What hobbies or sports do you participate in or have you participated in?

Please check as many activities below as you feel comfortable teaching at Kennolyn

List 3+ activities you feel most qualified to teach. List training, experience and note any certifications you hold.

REFERENCES: Give the name, address, and phone number of at least three people who have knowledge of your character, experience, and ability with regard to the position for which you are applying. DO NOT LIST RELATIVES. In addition, send each person a reference form that should then be forwarded to Kennolyn by the referee to support your application.

All of the following questions must be completed for your application to be considered:

Have you ever been convicted of, or are you currently released on bail or on your own recognizance following arrest and pending trial for, any sex crimes, drug crimes, or crimes of violence?

Have you ever been convicted of a crime? Convictions will not necessarily disqualify you from employment.

If you answered yes to either of the previous two questions, please provide a full explanation, including the nature of the crime, the date and location of any court hearings, and the disposition of the case below.

All employees who hold driver's licenses are expected to drive in emergency situations. You may be required to submit a copy of your State Licensing Department driver's report to Kennolyn before you are considered for a position.

Drivers License Number:

State

Issue date and Expiration Date:

Give details of any former employment – ESPECIALLY AT CAMPS, PAID OR UNPAID. List your most recent employment first:

Employer Name, State, Dates Employed, Supervisors Name and Contact Information

Are you aware of Kennolyn’s grooming and dress code standards?

Do you have any visible tattoos when wearing a bathing suit?

Do you have any body piercings?

Are you willing to abide by Kennolyn's "No alcohol, No illegal drugs, No smoking" policy?

Have you ever been fingerprinted as part of a job application?

Are you willing to have your fingerprints taken and processed through state and federal agencies and/or submit to a background check conducted by an agency or organization of Kennolyn’s choosing?

Being a camp counselor means being in the out-of-doors for much of the day and living in rustic conditions. Counselors may be required to: lead a hike of up to 4 miles; spend 24 hours, including sleeping under the stars, in the forest in close contact with trees and dust; be around horses or animals; live in a rustic cabin with screen windows, bunk beds and electricity, sharing a community bathroom with hot water and showers. Are you able to perform these duties?

If your answer is no, which of the specified duties are you unable to perform?

If you will require accommodations to perform these duties, please describe:

DIRECTIONS: PLEASE READ AND INITIAL THE FOLLOWING CAREFULLY BEFORE SIGNING THIS APPLICATION FORM

If I am offered employment, I will, as a condition of employment, be required to submit proof of my identity and legal right to work in the United States.

I hereby certify that I have personally completed this application and that the answers given by me to the foregoing questions and statements are true and complete and that no material fact has been omitted. I understand that any false statements appearing on this or any other employment form will be sufficient reason to end further consideration of this application and not hire me; if discovered after my employment, such false statement will be sufficient reason for dismissal from the services of Kennolyn regardless of the time that has elapsed before discovery.

I authorize Kennolyn or it’s designated agents to contact my references and to investigate my past employment, credit history, education credentials, Department of Motor Vehicles driving record, and other employment-related activities, without giving me prior notice of such disclosure. I agree to cooperate in such investigations and release those parties supplying such information to Kennolyn from all liability or responsibility with respect to information supplied to Kennolyn.

If employed by Kennolyn, I agree to abide by the rules, policies and procedures of Kennolyn and subsequent rules, policies and procedures that may become effective after employment. I understand that my initial and continued employment may be contingent upon the successful completion of a medical examination, and such examination may include drug and alcohol screening. I understand that Kennolyn believes strongly in a drug-free work environment and agree to abide by the drug and alcohol policies during the time of my employment.

Please write a biographical sketch. Tell us about yourself, your life, your reason for applying to Kennolyn etc. List any other information you think might have some bearing on your application. We are interested in knowing what you do for fun and your future goals as well as why you feel you are a good role model for children and teens.

Signature and Date

Your Application is now complete. If you would like to complete the Background Release you may do so now or wait and do so at a later date as determined by the application process. Completing this form now or at a later date will have no effect on your application.

In connection with my application for employment or proposed contract for services, I understand that investigative background inquiries are to be made on me that may include criminal, vehicle, credit and other reports. These reports may include information as to my character, work habits, performance and experience along with reasons for termination of past employment from previous employers. Further, I understand that you may be requesting information from various Federal State, and other agencies, which maintain records concerning my past activities related to my driving, criminal, civil and other experiences. Upon written request, additional information as to the nature and scope of these background checks will be provided. I authorize without reservation, Diligent Data Service to furnish any of the above-mentioned pieces of information. I understand that to aid in the proper identification of my file or records, the information requested below is required. This information will be used for identification only and will not, except as expressly job related, form the basis for an employment decision. Please include any previous addresses where you have resided over last ten years.

NOTICE TO CALIFORNIA APPLICANTS

Under California law, the consumer reports we order on you are defined as investigative consumer reports. These reports may contain information on your character, general reputation, personal characteristics and mode of living.

I want to receive a free copy of any investigative consumer report requested on me by checking this box

Under section 1786.22 of the California Civil Code, you may view the file maintained on you by Diligent Data Service during normal business hours. You may also obtain a copy of this file upon submitting proper identification and paying costs of duplication services, by appearing at Diligent Data Service in person or by mail. You may also receive a summary of the file by telephone. The agency is required to have personnel available to explain your file to you and the agency must explain to you any coded information appearing in your file. If you appear in person, a person of your choice may accompany you, provided that this person furnishes proper identification.

Name:

Date of Birth

Sex

Social Security Number

Drivers License Number and State

Current Address and Previous Addresses

Applicants Signature and Date:

If you need anything regarding the application please feel free to email your questions to chris@kennolyn.com. You will get an email confirming receipt of your application once we review it. You will also receive the Reference form via email. Thanks and GOOD LUCK!

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Ropes Course	Climbing	Mountain Biking
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