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Positions Available: RN; LPN; Pharmacy Tech

What Position Are You Applying For?

Personal Information

First Name	Last Name


Social Security Number	Email Address


Current Phone Number	Home/Permanent Phone Number


Current Address	Home/Permanent Address


Optional Information

Date of Birth	Gender


Are You Married?	List Children (age/gender)


How Did You Hear About Us?	Please Explain, If Necessary


Education

University/College


Major	Years Completed By June


Previous Employment

Employers' Name


Position	Phone Number


Contact Person	Dates of Employment



Employers' Name


Position	Phone Number


Contact Person	Dates of Employment



Employers' Name


Position	Phone Number


Contact Person	Dates of Employment

Please spend some time considering the following questions which will help us to determine your ability to work at the position applied for.

A. List any courses that you have taken that would relate to working with children

B. What do you think are the most important aspects to being a good camp nurse?.

C. What do you think a child wants to get out of the camp experience?

D. What do you think a parent wants their child to get out of the camp experience?

E. Finish the following sentence. "I am happiest when...

F. Who has had the biggest influence in your life and why?

G. List any leadership positions that you have held

H.	Have you ever been convicted of a felony or misdemeanor?	Have you ever been or involved in an incident involving sexual or physical abuse of a child?


If you answered yes to either of the above questions, please explain the circumstances.

PLEASE BE AWARE THAT WE CONDUCT BACKGROUND CHECKS ON ALL EMPLOYEES.

Please review the above application before clicking the Submit button. Submitting this form will serve as your acknowledgment that the above information is correct.

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