Staff Application

In accordance with the Children's Online Privacy Protection Act, a person must be 13 years of age or older to complete and submit this form. Please Fill Out & Complete All fields. Use The Pointer to Move Between Fields.

Personal Information
Permanent Address
College Address
Applicant's Mount Tom History
(i.e. 2001-2005)
Work History
Please list most recent first
Job 1
Job 2
Job 3
Job 4
Position Interest
(hold down CTRL key to select multiple items)
Dates Available
Applicant's Other Camp Experience
Educational Background
Grad School
College/Univ
High School
Skills & Certifications
Multiple items may be chosen
Program Skills
Next to the following sports/activities, put a "1" where you can organize and teach; "2" by those you can assist:
Please describe other areas of your expertise that might result in new programs for our campers (ages 3-13).
References & Record
Please list people who know your character, strengths, work ethic, personality, etc. (other than family).
Reference 1
Reference 2
Reference 3
Harassment
The camp's policy is to prohibit all forms of harassment by our employees. This includes sexual, racial, religious, and other forms of harassment. Have you ever been accused of harassment of any person including, but not limited to workplace harassment? (Note: a prior accusation or conviction is not an automatic bar to employment. The type of conviction or accusation and when it occurred will be evaluated by the camp before any decision is made).
Criminal Record
Have you ever been convicted of a crime, other than a minor traffic offense? If yes please describe. (Note: a prior conviction is not an automatic bar to employment. The type of conviction or accusation and when it occurred will be evaluated by the camp before any decision is made).
I authorize investigation of all statements herein, including any checks of criminal records, 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 unless there is an agreement or law which alters that status. Furthermore, I understand that any agreement must be in writing and signed by the designated camp official. I also understand that untrue, misleading, or omitted information herein or in other documents completed by the applicant may result in dismissal, regardless of the time of discovery by the camp.