JEWISH COMMUNITY CENTER OF GREATER PITTSBURGH 5738 FORBES AVENUE BOX PITTSBURGH, PA (412) FAX (412)

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1 JEWISH COMMUNITY CENTER OF GREATER PITTSBURGH 5738 FORBES AVENUE BOX PITTSBURGH, PA (412) FAX (412) APPLICATION FOR EMPLOYMENT (SUMMER SEASONAL/TEMPORARY) The Jewish Community Center of Greater Pittsburgh (JCC) is an equal employment opportunity employer. The JCC does not discriminate against employees or applicants for employment on the basis of race, sexual orientation, religion, age, national origin, disability, or any other status or condition protected by applicable federal, state, or local laws. We are a drug free workplace. Please print all information requested below Referral Source: Advertisement Friend Relative Walk-in Other PERSONAL INFORMATION (Last) (First) (MI) Social Security Number Permanent School Cell Phone (Street) (City) (State) (Zip) (Street) (City) (State) (Zip) (most used) Are you a citizen of the United States? Yes No If No, do you have work papers? Position(s) applying for Are you able to perform the essential functions of the position for which you are applying either with or without reasonable accommodations? Yes No If necessary, please describe what type(s) of reasonable accommodations are needed: Are you currently employed? Yes No If yes, may we contact your present employer? Yes No Have you ever applied for a position with this agency before? Yes No If Yes, when? Were you previously employed by us? Yes No If Yes, when? Position If you are under the age of 18, will you be able to furnish a work permit after employment? Yes No EDUCATION, TRAINING, AND SKILLS List all education and training, including high school, college, trade, technical, vocational, business or military schools. HIGH SCHOOL Years Attended Area of Concentration Diploma/Degree Earned COLLEGE PROFESSIONAL/ TRADE/BUSINESS

2 PREVIOUS EMPLOYMENT Account for all employment and all periods in excess of two weeks in the past 10 years, including U.S. Military Service and volunteer work experience. Start with your most recent position and work backward. A resume may be used to supplement the Application for Employment, but you must complete all information requested on the application. Do not write See Resume on the application. (If additional space is required, attach an additional sheet.) Agency Supervisor s of employment: From To Position last held Reason for leaving Ending salary Agency Supervisor s of employment: From To Position last held Ending salary Reason for leaving PROFESSIONAL REFERENCES Relationship to you Relationship to you Title Telephone Title Telephone GENERAL Have you ever been convicted of a crime or violation other than a minor traffic infraction? (Note: A conviction will not necessarily disqualify an applicant from employment. Each case will be considered on its own merits.) Yes No If yes, please explain and state charge, court date and disposition of case: I certify that this application was completed by me and the entries contained in this application are true and complete to the best of my knowledge. I understand that misrepresentation or omission of facts requested on this application may be grounds for rejection of this application or dismissal from employment if subsequently discovered. I authorize an inquiry which may provide information background concerning my character, general reputation, and past work performance. I hereby authorize the agency to inquire, and also authorize and request each former employer, educational institution, personal credit bureaus, governmental and law enforcement agencies to answer all questions which may be legally asked, and to release all information which may be legally sought. I hereby release all parties from any liability or responsibility for doing so. I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice. I further understand that only the Executive Vice President of the JCC has the authority to create or enter into any employment contract on behalf of the agency. If hired, I agree to comply with all rules, regulations, and employment polices of the Jewish Community Center of Greater Pittsburgh. Signature of Applicant

3 EMMA KAUFMANN CAMP ADDENDUM Please Return To: Emma Kaufmann Camp 5738 Forbes Avenue Pittsburgh, PA ATTN: ADAM BARON Dear EKC Staff Member: STAFF APPLICATION For Office Use Only: Sent Returned Interview Hired The selection of staff at EKC is extremely important to us. We look for candidates that want to be at our camp to be a positive member of a team of people dedicated to providing a unique and quality experience to the campers. We work hard to make the camp experience great for our staff and want everyone to have fun and enjoy their summer. We do, however, want staff that understand that campers come first and working with them and making their summer the best it can be is the number one priority. In addition to the general information, please take time to thoroughly answer the questions on the following pages. Contact any one of the full-time EKC staff to get answers to any questions, for more information or to get an application for friends or anyone that may be interested in being EKC staff. (PLEASE PRINT OR TYPE) Full Cell Phone PREVIOUS EKC EXPERIENCE Total Years at EKC (circle all that apply) Camper Staff Availability & Interest What position at Emma Kaufmann Camp are you applying for? Are you able to work the entire camp season (June 16 August 18)? Yes No If no or not sure, when are you available? From to Are you interested in pre-camp work? Yes No s: Are you interested in post-camp work? Yes No s:

4 Please answer the following questions Tell us about a time when you put the needs of another or others ahead of you own. What was the situation? What was the relationship between you and the person/people? How did you handle the situation? What did you learn? If we contacted your campers after the summer, what would you want them to say about you? Be specific. Describe a time when you weren t very satisfied or pleased with your performance? What did you do about it? Provide an example of a time you made an important decision. How did you make the decision? How does it affect you today? What do you think are parent s biggest concerns for their child/children who are attending overnight camp?

5 SKILLS INVENTORY Place a 1 before those activities you can lead, organize and/or teach. Place a 2 before those activities you can assist in teaching. Place a 3 before those activities in which you have participated and have some skills. JEWISH PROGRAM SKILLS ATHLETICS CERTIFICATIONS Leading Shabbat Services Archery Certificate Expiration Hebrew Language Basketball CPR Torah Reading Aerobics First Aid Bar/Bat Mitzvah Tutoring Soccer Lifeguard Israeli Culture Tennis WSI Israeli Dancing Hockey Canoeing Field Hockey Boat Driver Lacrosse ARTS & CRAFTS Volleyball AUDIO VISUAL Drawing Golf Photography Painting Ultimate Frisbee Video Candle-making Softball DJ Equipment Ceramics/Firing Kiln/Clay Firiing ADDITIONAL ACTIVITIES Photography Horseback Riding Mosaics Mountain Biking/BMX PERFORMING ARTS Creative Dramatics Acting Directing Staging/Props Improvisation Dance OUTDOOR ADVENTURE Backpacking Overnight Camping Nature Activities Outdoor Cooking Orienteering GPS/Geocaching Repelling High Ropes Low Ropes Rope Course Training Team Building MUSIC Hebrew/Israeli Choir/Voice Song Leading *What musical instrument do you play? AQUATIC ACTIVITIES Lifeguarding (Pool or Lake) Competitive Swimming Swimming Lessons Synchronized Swimming Kayaking Canoeing Water Skiing Boat Driving Use the space below or attach a separate paper to describe or explain any of the skills you listed above I understand that the information provided in this application is correct and truthful. I authorize EKC to utilize the above information for the purpose of obtaining a criminal and child abuse history file search as part of their pre-employment screening process. Signature