Camp Modin Staff Application Contact US.

MANDATORY DATES OF CAMP FOR STAFF
June 17, 2009 through August 13, 2009
(some specialty staff arrive earlier for additional training)

In order to apply for a position you must be 19 years of age or turning 19 shortly after the summer. We do not hire graduating high-school seniors, except in the case of former campers. Please complete all three pages of this application. Make sure to click the 'submit' button on the third page and wait for the 'application completed' notice. Failure to receive this notice will result in an error. If you have any questions or problems completing your application email us at modin@modin.com.

GENERAL INFORMATION
First Name:* Last Name:*
Birthdate:* Age by June 1st:*
Gender:* Social Security #:
(US Residents Only)
Email address: INSTANT
MESSENGER
ACCOUNTS:
AIM:
MSN:
Yahoo:

HOME ADDRESS
Address Line 1:*
Address Line 2:
City/Town:*
State/Province:*
Zip/Postal Code:*
Country*:
Home Phone:*
Cell/Mobile Phone:
SECONDARY ADDRESS
Address Line 1:
Address Line 2:
City/Town:
State/Province:
Zip/Postal Code:
Country:
Phone:
   

ADDITIONAL INFORMATION
Marital Status:
Staff Shirt Size:
Height: (optional)
Weight: (optional)
Occupation or Year in School:
Driver's License #:
State/Prov. & Country:
Expires:
 
Camp Modin is a smoke-free environment. Do you smoke?* Yes No
Do you have any tatoos or body-piercings? Yes No
If yes, please describe:
Do you suffer from any physical, psychological, or emotional impairments?* Yes No
If yes, please describe:
Are you currently taking any medications for psychological or emotional impairments?* Yes No
If yes, please describe:
Have you ever been arrested or convicted of a crime including, but not limited to sexual abuse or child abuse?* Yes No
If yes, please describe:
Have you ever been charged with DUI (Driving Under the Influence of alcohol)?* Yes No
If yes, please describe:
What type of position are you looking for?
 What dates are you available to work?
What was your last camp salary?
 What is your age group preference?
Describe any camp experience you've had either as a camper or as a staff member:
Describe any additional experience you have had working with children and list their ages:

How did you hear about Modin?
Search Engine (e.g. Google, Yahoo, etc.) Please specify:
Website Please list:
Friend / Former Staff Member Please list name:
Agency (e.g. CCUSA, CampAmerica, etc.) Please specify:
Other Please specify:
I attended Modin as a camper    

EDUCATION LEVEL
High School Name Location
(city, state/prov, country) 		Years Attended  
 
College/University Name Location
(city, state/prov, country) 		Years Attended Major/Degree

CAMP EMPLOYMENT EXPERIENCE
Camp Name Location Director & Phone # Dates Employed Job Description

REFERENCES / WORK EXPERIENCE
Please list three references -- individuals or employers who have knowledge of your character, experience and ability. At least two must be work-related. If you are applying for a specialty position, please list two work-related references in your field of expertise, including teaching experience. References from your relatives, friends, neighbors and co-counselors or co-specialist are not acceptable. Teachers, professors, members of clergy, etc., are acceptable.
Name Relationship with individual or, if employer, nature of work Address Phone Dates employed or years known

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