BEAVER CREEK YOUTH CAMP

STAFF APPLICATION

Name: ___________________________________________________________________ Male or Female: ____________________

SS#: _________________________________________________ Date of Birth: ___________________________________________

Permanent Address: __________________________________________________________________________________________

Home Phone: ________________________ Cell Phone: ________________________ Email: ________________________________

Person to be notified in case of emergency: _______________________________________________________________________

Relationship of this person to you: _______________________________________________________________________________

Permanent Address: __________________________________________________________________________________________

Home Phone: ________________________ Cell Phone: ________________________ Email: ________________________________

Position you are applying for: ______________________________________ Date you are available to start: __________________

Have you had First Aid Training? ____________________________ Date Completed: _____________________________________

Have you had CPR Training? ________________________________ Date Completed: _____________________________________

Have you ever been convicted of or pled guilty to a crime, either a misdemeanor or a felony (including but not limited to drug-related charges, child abuse, unlawful sexual abuse, other crimes of violence, theft, or motor vehicle violations)? If yes, please explain: _____________________________________________________________________________________________________

____________________________________________________________________________________________________________

Do you have any physical or mental disability which would interfere with your ability to perform the job for which you are applying? ___________________________________________________________________________________________________

____________________________________________________________________________________________________________

Why do you want to work at BCYC? ______________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

EDUCATION:

School	Name and Location of School	# of years completed	Did you graduate?	Degree or Major
High School
College
Other (Vocational, Technical, etc.)

PREVIOUS WORK EXPERIENCE:

Name of Company/Employer

Address of Company/Employer

Job Title & Description of Duties and Responsibilities

Dates of Employment

REFERENCES: Please list three individuals who are not related to you by blood or marriage as references. Please list people who have known you for at least three years.

REFERENCES

Name:

Address:

Phone / email:

WAIVER AND CONSENT:

I, ____________________________________________, hereby certify that the information I have provided on this application for employment is true and correct. I authorize Beaver Creek Youth Camp (BCYC) to verify the information I have provided on this application by contacting the references and employers I have listed, by conducting a criminal records check, or by other means, including contacting others whom I have not listed. I authorize the references and employers listed in this application to give you whatever information they may have regarding my character and fitness for the job for which I have applied. Furthermore, I waive any rights I may have to confidentiality.

In the event that my application is accepted and I become employed by Beaver Creek Youth Camp, I agree to abide by and be bound by the policies of BCYC and to refrain from inappropriate conduct in the performance of my duties on behalf of BCYC.

I have read this waiver and the entire application, and I am fully aware of its contents. I sign this consent freely and under no duress or coercion.

SIGNATURE OF APPLICANT: _______________________________________________________ DATE: ________________________

 SIGNATURE OF PARENT/GUARDIAN

FOR APPLICANTS UNDER 18 YEARS OF AGE: __________________________________________ DATE: _______________________

Please fill out the Staff Application completely and return to: Beaver Creek Youth Camp, Attn: Camp Manager, P.O. Box 186, South Fork, CO 81154. (719) 873-5311.