2024 Camp Millhouse Staff Application

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Staff application and Voluntary Disclosure to allow for a background check. PLEASE READ EVERY QUESTION CAREFULLY TO BE SURE YOU ARE PROVIDING ALL THE INFORMATION REQUESTED. PLEASE NOTE: References (name, email & phone) must be provided or your application will not be considered.

Full Name (first, middle, AND last) *

Preferred Name *

Preferred Pronouns *

Are you 16 years old or older? *

Yes

COMPLETE Mailing Address (street, city, state, AND zip code) *

Best Phone number to reach you? *

Alternate phone number?

Email address that you check often? *

Please provide both: T-shirt Size? Sweatshirt Size? Example: L/XL *

Permanent address (if different from above). This will be the address that we send all paperwork to up until camp begins. If address is the same as above, answer N/A *

Parent/Guardian Name(s) First & Last *

Parent/Guardian Phone numbers - home and cell phones *

Parent/Guardian full address (street, city, state, zip code) *

Please check all positions you are applying for *

Nurse (RN or LPN must provide copy of current nursing license)

Graduate Nursing Student (must provide documentation)

Recreation Director (minimum age 18)

Arts & Crafts Director (minimum age 18)

Music Director (minimum age 18)

Special Activities (minimum age 18) includes evening program & photography/videography

Lifeguard (minimum age 18 and must provide proof of certification)

Counselor (minimum age 18)

Cabin Crew (minimum age 16)

Cook (minimum age 18) 2 shifts available , hiring 2 people per shift

Server/Kitchen Assist (minimum age 16) 2 shifts available, hiring 3 people per shift

Laundry (Must be available to work starting at 8 a.m. - should be done each day by 1 p.m.)

Dishwasher (minimum age 16)

Required

Education History - high school and beyond. Please provide all of the following: 1. School Name? 2. Year graduated or expected to graduate? 3. What is your degree in? *

Work History - Paid and Volunteer - Provide a full record of all employment and explain any gaps in employment. Include any positions on camp staff. If needed, email additional info to campmillhouse@gmail.com. Please provide: 1. Business Name? 2. Business full address & Phone? 3. Supervisor's Name? 4. Nature of work? 5. Reason for leaving? IF NO WORK HISTORY, TYPE "NONE" *

Reference #1 Name: CANNOT be a relative!
*

Reference #1 Email: *

Reference #1 Phone: *

Reference #2 Name: CANNOT be a relative! *

Reference #2 Email: *

Reference #2 Phone: *

Reference #3 Name: CANNOT be a relative! *

Reference #3 Email: *

Reference #3 Phone: *

5) Staff training begins on June 10, 2024 and the final day of camp is July 26, 2024. Can you commit to these dates? If not, please be sure to discuss with directors during your interview. *

Yes

Is there any additional information that you would like for us to consider when reviewing your application? If nothing, leave blank.

Do you currently hold any certifications? *

First Aid/CPR/AED

CPR/AED

Lifeguard

WSI

Food Safe Handler

None of the above

Have you had the COVID vaccination and/or boosters? (Not required for employment) *

Yes

If you've had the COVID vaccine and/or boosters, please provide the name of the Manufacturer and dates received. *

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 subject to any court order involving harassment of any person? (Note: a prior accusation is not an automatic bar to employment. The type of accusation and when it occurred will be evaluated by the camp before any decision is made.) *

Yes

Prior to the start of camp, you will be provided with a Staff Manual that will be reviewed in depth during training. The manual contains camp policies & procedures. Here are a few examples that will be discussed during the interview process. A) Camp Millhouse is alcohol, tobacco, vape & drug free. B) Staff under 18: Camp is responsible for you while you are on our property but you must check in with your family once you leave camp property. C) Curfew: All staff are required to be in their cabins by 11:15 p.m. & in bed/lights out by 11:30 p.m. D) Camp is a business-we expect our staff to have high integrity & behave in a manner fitting for any business. No gossiping or bullying! E) Cell Phone Policy – Cell phones are kept in director’s cabin and is available to staff at predetermined times. *

I understand

I agree that the information provided on this Application is truthful to the best of my knowledge. I understand and agree that if I have misled Camp Millhouse, Inc. with respect to the information provided on my application and/or the information provided to a staff person I will be terminated immediately. *

Yes

Type your full name below as your signature on this form. *

Today's Date *

YYYY

VOLUNTARY DISCLOSURE STATEMENT FOR ALL CAMP STAFF AND VOLUNTEERS. The following questions allow Camp to run a full background check which is a condition to employment at Camp Millhouse. *

I understand

Full Name - first, middle and last (our background check requires all three so if you do not have a middle name, please advise-i.e. John Smith - no middle name) *

Birthdate? *

YYYY

Home Address? *

Social Security? If you prefer to give this over the phone, you need to call the office when done with this form (574-233-2202) and fill in the answer as 111-22-3333 *

Other names by which you are known (i.e. maiden name). If none, please type none. *

Please provide both cell phone and home phone numbers *

Email address? *

Name of school/college along with full address. If none, type none *

Driver's License number, what state issued from, expiration date? Example: 1234-56-7890, IN, 1/1/21 *

1. Any previous residence(s) for last three years (include college and home residences): just list City, State and Year. Example: Sacramento, CA 1999-2009 *

2. Have you ever been convicted of any crime relating in any manner to children or adults and/or your conduct with them? *

Yes

If yes to question #2, please explain. If no, type N/A *

3. Have you ever been convicted of any crime including, but not limited to, those listed below and/or any crime similar in any manner to those listed here? A. Indecent assault and battery on a child under fourteen; B. Indecent assault and battery on any person with physical or intellectual disabilities C. Indecent assault and bettery on a person who has obtained the age of fourteen; D. Rape; E. Rape of a child under sixteen with force; F. Assault with intent to commit rate; G. Kidnapping of a child under sixteen with intent to commit rape; H. Distribution and trafficking of narcotics or other controlled substances; I. Intent to commit any of the above crimes. *

Yes

If yes to question #3, please explain. If no, type N/A *

4. Has there ever been a civil judgment against you involving sexual and/or physical abuse? *

Yes

If yes to question #4, please explain. If no, type N/A *

5. Are you now or have you ever been part of a federal, state, or court ordered registry involving sexual or physical abuse of any minor or adult?

Yes

Clear selection

If yes to question #5, please explain. If no, type N/A *

I understand that: A) The camp may deny employment to any person who answers “yes” to any one of questions 2-6. If hired and the employer later discovers circumstances that would indicate a “yes” answer to any of the above questions, employment may be terminated immediately. B) The information provided on this form is subject to verification, which may include a criminal history check and request from any Central Registry of child abusers. C)The camp may terminate employment or volunteer service of any person if that person is found, regardless of when discovered, to: 1) have a history of complaints of abuse; 2)have resigned, been terminated, or been asked to resign from a position whether paid or unpaid, due to complaint(s) of sexual abuse; and/or 3)have falsified or omitted information in this disclosure statement. and D) This disclosure statement must be updated yearly. *

I UNDERSTAND

Typing your name here serves as your legal signature of this form *

Today's Date? *

YYYY

Minor’s Parent or Guardian - typing your name here serves as your legal signature of this form. If you are 18 or over, you do not require parent/guardian signature so just type "N/A" *

Date of Parent/Guardian signature if signature required

To schedule your interview, please scan the QR code. If the times do not fit your availability, please contact the office at campmillhouse@gmail.com or 574-233-2202. No interviews are done on weekends or holidays. We look forward to speaking with you!

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