Kawkawa Camp and Retreat, Hope BC | 2016 Summer Staff Application

First Name *

Last Name *

Email Address *

Male/Female *

Your Unique Camp Name

Date of Birth *

Today's Date *

(auto)

Age *

(auto)

Address *

City *

Postal Code *

Primary Phone Number *

Alternate Phone Number

T Shirt Size

Emergency Contact *

Phone *

Social Insurance Number *

Care Card Number *

How/Where did you hear about Kawkawa Camp and Retreat? *

Position(s) You Are Applying For *

Available Start Date

Last Available Date

Why do you want to serve on staff at Kawkawa this summer? *

What would you hope to receive from the summer camping season at Kawkawa?

Personal References

Please include names, phone contact and email address of 3 references we can contact. Try for one pastoral, one adult friend and one teacher / employer.

Reference 1: Name / Phone / Email *

Reference 2: Name / Phone / Email

Reference 3: Name / Phone / Email

About You

School now attending

Last Grade Completed *

Place of employment

Position *

School positions of responsibility

Describe your Role and approximate dates

Other positions of responsibility

Describe your Role and approximate dates

Previous job or camp experience *

Have you completed a Leadership/Counselor-In-Training program? *

Yes

No

If yes, when? Also, what additional applicable training?

Personal Skills

Which activity experience and qualifications do you have?

Select one per activity.

Archery *

Competent To Lead

Can Teach

Have Some Experience

Never done

Canoeing *

Competent To Lead

Can Teach

Have Some Experience

Never done

Kayaking *

Competent To Lead

Can Teach

Have Some Experience

Never done

Wakeboarding *

Competent To Lead

Can Teach

Have Some Experience

Never done

Arts and Crafts *

Competent To Lead

Can Teach

Have Some Experience

Never done

Riflery *

Competent To Lead

Can Teach

Have Some Experience

Never done

Guitar or other musical instrument(s) *

Which instruments?

Outdoor Skills *

Competent To Lead

Can Teach

Have Some Experience

Never done

Song Leading *

Competent To Lead

Can Teach

Have Some Experience

Never done

Wide Games *

Competent To Lead

Can Teach

Have Some Experience

Never done

Drama

Competent To Lead

Can Teach

Have Some Experience

Never done

Group Initiative Tasks *

Competent To Lead

Can Teach

Have Some Experience

Never done

Devotionals *

Competent To Lead

Can Teach

Have Some Experience

Never done

Kitchen / Cooking *

Competent To Lead

Can Teach

Have Some Experience

Never done

Administration *

Competent To Lead

Can Teach

Have Some Experience

Never done

Maintenance *

Competent To Lead

Can Teach

Have Some Experience

Never done

Multi-Media *

Competent To Lead

Can Teach

Have Some Experience

Never done

Program *

Competent To Lead

Can Teach

Have Some Experience

Never done

First Aid *

Competent To Lead

Can Teach

Have Some Experience

Never done

Lifeguard *

What level of certification?

Please list additional skills or expand on any of the above.

Please list any special licenses, certifications, or qualifications *

i.e. WSI . NLS, RN, CPR, 1st Aid, Food Safe, Life Guard, Driving License, Boaters License, etc

What is the most responsible position you have had, and why were you in that role? *

Are there circumstances or traits in your lifestyle or background that would call into question your ability to work with children or youth? *

Yes

No

Have you ever been arrested or convicted for the use or sale of drugs? *

Yes

No

Have you ever been hospitalized or treated for alcohol or substance abuse? *

Yes

No

Have you ever been convicted of a criminal offense? *

Yes

No

Do you have any pending criminal charges or convictions? *

Yes

No

Have you ever been accused, arrested/convicted for any abuse-related crimes? *

Yes

No

Have you ever been the subject of any disciplinary action (including discharge) or investigation by a church, religious or other organization, or by an employer? *

Yes

No

Do you have any physical condition which would limit your capacity for the job(s) applied for or health concerns of which we should be aware? *

Yes

No

Do you have any type of special diet? *

Yes

No

If you have answered “yes” to any of the above questions, please explain. *

Personal Consent

I consent to my name, address, phone number, and email address, being made available to staff of Kawkawa Camp & Retreat in the “Summer Staff” list. *

Yes

No

I agree to my picture being used by Kawkawa Camp & Retreat for program, promotional & publicity purposes. *

Yes

No

I agree to consent to a Police Criminal Record Check and will have this delivered to the camp prior to my arrival on the campsite.

Yes

No

To the best of my knowledge, all information which has been given in this form or during any interview, is accurate and complete. I understand that in the event of my application being accepted by Kawkawa, I shall be subject to dismissal if any of the information I have given is false or if I failed to give any material information herein requested. *

Yes

No

Please upload a recent photo of yourself. *

Maximum file size: 57.67MB

Limit the image file size to 1MB max please.
File formats jpg, png and pdf are accepted. Thx.

Signature *

Clear

Summer Staff Application

Please review the application before beginning to ensure you have all the information you’ll need near at hand to complete the form successfully.

Personal References

About You

Personal Skills

Personal Consent

About Kawkawa

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