REQUIRED FIELDS HAVE GREEN LETTERS

PLEASE ENTER ALL DATES IN FORMAT MM/DD/YYYY, I.E. 02/26/2007

PLEASE ENTER ALL PHONE NUMBERS IN FORMAT AAA-BBB-CCCC, I.E. 212-555-1212  

PLEASE ENTER ALL ZIP CODES IN FORMAT AAAAA OR BBBBB-CCCC, I.E. 11003 OR 11003-2635  

First Name:   Last Name:

  Email:          Cell Phone:

Will You Be 18 Years Of Age By The End The Year?   YES:    NO:   Age (optional):  
 
Current Address: Permanent Address:
Street:    Apt: 

City:       State:   Zip:

Phone:  		   Street:    Apt: 

  City:       State:   Zip:

  Phone:  

Until What Date Can We Send Mail To Your Current Address?  
 

  
Position for which you are applying:

  Dates Available:     From Date:   To Date:

Present Occupation or School now attending :  

Education
High School:                        From Date:     To Date:    Major:
 
College/Trade School:     From Date:     To Date:    Major:
 
Graduate/Other:               From Date:     To Date:    Major:
 
Specify any Course Work and / or Training applicable to camp:
 
Have you Traveled in the U.S. or Abroad? IF So, Where?             

Camp Employment Experiences

 
   
NAME OF CAMP CITY  /  STATE POSITION FROM & TO DATES DIRECTOR PHONE #
     
     
     

Other Employment Experiences

 
COMPANY CITY  /  STATE POSITION FROM & TO DATES SUPERVISOR PHONE #
     
     
     

References
1
2
3
NAME:

NAME: 

NAME: 

TITLE:

TITLE:

TITLE:

ADDRESS: ADDRESS: 

ADDRESS:

CITY:

CITY:   

CITY:   

STATE:

    ZIP: 

STATE:  

    ZIP: 

STATE: 

    ZIP: 

PHONE#:

PHONE #: 

PHONE #: 

Certifications
PLEASE LIST ANY CERTIFICATIONS AND THEIR EXPIRATION DATES
 
CPR:
Certifying Agency    Exp. Date 		CANOEING/BOATING:
Certifying Agency    Exp. Date
FIRST AID:
Certifying Agency    Exp. Date 		CHALLENGE/ ROPES CERTIFICATION:
Certifying Agency    Exp. Date
LIFEGUARD TRAINING:
Certifying Agency    Exp. Date 		WATERFRONT SAFETY INSTRUCTOR:
Certifying Agency    Exp. Date
WATERFRONT MODULE: 
Certifying Agency    Exp. Date 		WILDERNESS FIRST RESPONDER:
Certifying Agency    Exp. Date
OTHER CERTIFICATION:       Certifying Agency    Exp. Date
DRIVER'S LICENSE:   ID NUMBER   STATE    Exp. Date
 
PLEASE ANSWER THE FOLLOWING QUESTION. THIS QUESTION IS INTENDED TO HELP TRAIL BLAZERS KNOW A BIT MORE ABOUT YOU. IT IS NOT INTENDED TO BE AN INVASION OF PRIVACY.
 
1. Write a brief, but complete and informative autobiography including some thoughts about your upbringing, meaningful childhood experiences, your present interests and hobbies, and your future plans.

 
2. Describe any experiences you have had living and/or working with people of other cultures/ethnicities/religions and how these experiences have influenced you.

 
3. Why do you want to work at Trail Blazers and what are your personal expectations of the summer?


Other Questions
 

How Did You Find Out About Trail Blazers (If From The Internet, Please Give Specific Site)?

With What Age Children Would You Prefer To Work, And Why?

Have You Ever Been Convicted Of Child Abuse/Sexual Assault?   YES:    NO:    If Yes, Please Explain.

Have You Ever Been Convicted Of Any Other Crime?   YES:    NO:    If Yes, Please Explain.

Do You Speak A Foreign Language?   YES:    NO:    If Yes, Which And At What Level?

Do You Have Any Impairments (Physical, Mental Or Medical) Which May Effect Your Job Performance And If So, Should It Be Taken Into Consideration In Job Placement?

Dietary Restrictions / Preferences Or Food Allergies
Do You Smoke?  YES NO   If Yes, Are You Prepared To Smoke Only From 9pm To Midnight In Designed Areas? YES NO  N/A
 

Please Feel Free To Make Any Additional Comments Here.

TRAIL BLAZERS IS AN EQUAL OPPORTUNITY EMPLOYER