2010 Staff Application

Name:
Email Address:
Position Applying For:
Date of Birth:
Street Address:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
Select the activities you can assist with and the activities you can lead:
ActivityAssistLead
Arts & Crafts
Boogie Boarding
Drama
Music
Ocean Safety
Sports
Surfing
Swimming
Are you currently certified in First Aid:     If yes, expires when?
Are you currently certified in CPR:     If yes, expires when?
Are you currently certified
in water safety instruction:		     If yes, expires when?
Give a brief description (include dates) of any prior experience in the following activities: Water Polo, Swim Team, Jr. Life Guard, L.A. County Life Guard, Hammerhead Beach Camp (Staff or Camper)
Select the session(s) that you are available to work:
SessionAMPM
Week 1 (June 28 to July 2)
Week 2 (July 6 to July 9)
Week 3 (July 12 to July 16)
Week 4 (July 19 to July 23)
Week 5 (July 26 to July 30)
Week 6 (August 2 to August 6)
Week 7 (August 9 to August 13)
Week 8 (August 16 to August 20)
Week 9 (August 23 to August 27)
Educational Background:
(Paid Positions Only)
High School Attending
Graduation Date
College/University Attending
Graduation Date
Employment Experience:
(Paid Positions Only)		Please list all of the camps or children's programs in which you have been employed. Please include organization, location, and position held.
Did you attend a summer camp:   If Yes, which one:
Please list 2 references (other than family members) who are able to evaluate your qualifications regarding the position for which you are applying:
Reference #1:
Name:
Phone Number:

Reference #2:
Name:
Phone Number:
I certify to the best of my knowledge that the
information given above is Truthful and Correct.
Enter your initials here (for your digital signature*):
*By entering your initials above, you are stating that the information in this form is correct.
Uniform Sizes:
T-Shirt:
Sweatshirt:
Swimsuit (women 28-38):
Board Shorts (women 2-14):
Board Shorts (men 30-38):