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Name:
Current Address :
City:
State :
Zip:
Permanent Address :
City:
State:
Zip:
E-mail Address:
Social Security #:
Current Phone:
Current Address Valid Until:
Permanent Phone :
Drivers License#:
State of Issue:
Drivers License Expiration Date:
Staff persons must be twenty-one years of age. Do you meet this requirement?
Name(s) of Catalina Island Camps staff members(s) you know:
Dates available?

Please Indicate, on a scale of (1-5), your experiences with the following( with 5 being very experienced and 1 being no experience):


Science

Marine Biology
Terrestrial Science
Environmental Science
Astronomy

Program Activities

Skin Diving
Sea Kayaking
Climbing Wall
Ropes Course
Initiative Activities
Composting/Gardening
Boat Handling
Group Leadership

School Programs
Environmental Programs
Summer Camp Programs
Other
 
What position are you applying for?

Certifications:(All staff must be First Aid/CPR/Lifeguard certified at the start of their employment)

First Aid   Course Provider Expiration Date
CPR   Course Provider Expiration Date
WSI   Course Provider Expiration Date
Lifeguard   Course Provider Expiration Date
Other Course Provider Expiration Date
Other Course Provider Expiration Date

 

Education
College/University
Location
Dates Attended
Degree
College/University
Location
Dates Attended
Degree

Employment History(Paid & Volunteer. Include jobs listed under "Previous Group Leadership Experience")
Position Held:
Employer Name:
Phone#:
Phone#2:
Supervisor:
Dates Employed:
Location:
 
Position Held:
Employer Name:
Phone#:
Phone#2:
Supervisor:
Dates Employed:
Location:
 
Position Held:
Employer Name:
Phone#:
Phone#2:
Supervisor:
Dates Employed:
Location:

Previous Group Leadership Experience (Particularly with young people.)
Organization Name:
Location:
Phone#:
Supervisor:
Position:
 
Organization Name:
Location:
Phone#:
Supervisor:
Position:
 
Organization Name:
Location:
Phone#:
Supervisor:
Position:
Describe all relevant academic training (specific college courses, field study or other study programs)

How did you here about Catalina Island Camps/CELP (Please be as specific as possible)

References (Please list the names of two people who will submit references to your character, skills, and experience. Do not list relatives or friends. Ask each of these people to send a letter of reference to us that addresses their direct observations of your abilities, character and other pertinent information. Your application is not complete until we receive both references. References should be mailed to
Po Box 94146, Pasadena,CA 91109)
Name:
Relation:
Phone#:
 
Name:
Relation:
Phone#:
Short Answer Questions - (Two - three paragraphs each)

Describe experiences you have had that qualify you to be a CELP instructor:

Describe the most rewarding experience you have ever had with a child or group of children:

Describe a successful team you were a part of and your role in its success (work,school,sports etc.):
Have you ever been convicted of a crime involving alcohol, drugs, sex or violence? Yes No

If yes please explain:

PLEASE READ THE FOLLOWING INFORMATION: I certify that all the statements and information on this application are accurate and complete, and I understand that any employment offer is based upon the accuracy of this information. Any false statements, omissions or inaccuracies of this application will be just cause for my disqualification or dismissal. By typing AGREE in this box, I understand and agree to the above paragraph.