First Name*  Name you want to be called *  Last Name*     

Gender M F        Marital Status Single Married

Home Street*    City*    State*    Zip*

Position you are applying for Counselor Aide  Counselor  Swim Instructor  Specialist Division Leader

Grade Preference Nursery/Kindergarten 1^st/2^nd Grade 3^rd/4^th Grade 5^th Grade & Above Teen Program

Would you be interested in driving a bus route? Yes No         (must be 21 years of age to drive a bus)

Would you be interested in being a bus counselor? Yes No   

Current Occupation                         I am a full time Student

Do you have any children who one day will attend camp? Yes No      Current Ages?

Please select any certifications you may have and list their expiration dates

Describe any previous camp experience you have had as a camper or staff member.

What experience do you have in the area you are applying for?

Rate yourself in the following qualities 10 = Excellent       9 = Very Good       8 = Good        7 = Fair

How would you describe yourself to someone who didn't know you and what are your strongest qualities?

How will campers benefit from having you as a counselor?

How did you hear about Harbor Hills? College Paper Local Newspaper Online Ad Yellow Pages Friend

Did anyone recommend you to us? Yes No
If yes, please include the person's name

Have you ever been convicted of a crime other than a minor traffic violation? Yes No

If yes, please explain in detail

2007 Camp Season Monday, June 25th - Friday, August 17th (Monday - Friday, 8:30 AM to 4:00 PM)

Do you have any conflicts with the above dates? Yes No
If yes, briefly explain

By typing AGREE below and by electronic submission of this application

1. I am giving authorization to Harbor Hills Day Camp to do a full background search.
   
2. I certify that all the statements and information on this application are accurate and complete.
   I understand that any employment offer is based upon the accuracy of this application. If I
   am hired for a position, I understand that any false statements, omissions or inaccuracies
   on this application may be cause for dismissal.
   

* Please type "AGREE" here