Winter Dear Hartford County 4-H Camp Staff Applicant,

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1 Winter 2016 Dear Hartford County 4-H Camp Staff Applicant, Thank you for your interest in our camp! Hartford County 4-H Camp, Inc., serves over one thousand children each summer. With activities like archery, canoeing, low ropes challenge course, nature, arts and crafts, athletics, horseback riding lessons and more, the campers have a memorable, fun-filled week during their stay. A crucial part to our program s success is the enthusiastic, hard working, and caring camp staff team. Your experience at camp will be one full of adventure, challenges and meeting of new friends that will last a lifetime! Our summer season is as follows: June 16: Staff arrival and start of training All staff required to attend June 17, 18 & 19: CT 4-H All Camp Staff training at Windham/Tolland 4-H All staff required to attend June 20-24: Staff training: All staff required to attend June 24, 25 & 26: Teen Counselor Training TBA which staff are required to attend June 26- July 2 Horse Camp: Cabin Coordinators, Waterfront, Horse and Kitchen staff are required to work June 29 & 30 Mini Camp: All staff required to attend July 3-August 20: 1 week camp sessions All staff required to attend Enclosed you will find an Application, three Activity Lesson Plans and a general Job Description for an Activity Staff position. Typically, our staff teaches three 1-hour activities four days of the week. Please submit the following: Application Lesson plans for a week session activities you would like to teach to campers, ages 9-14, and include: o rainy day plan, learning objectives and debriefing and take home messages o Resume and any other pertinent certifications and/or documents Please complete the aforementioned thoroughly and return to the address listed on the application. Due to the fact that you potentially will be working closely with impressionable children this summer, we ask that you scrutinize any networking websites, blogs or any public site to ensure that you are portrayed in a positive manner. When your application is received, the Staff Procurement Committee will review it and then be in contact with you for an interview. If you should have any questions, please do not hesitate to contact me via burrowsinmaine@gmail.com or by phone, (207) until June. Sincerely, Heidi Burrows, Camp Director Hartford County 4-H Camp, Inc.

2 Hartford County 4-H Camp, Inc Staff Application An Equal Opportunity Provider and Employer Camp Sessions: June 26-August 20 NAME Birth Date / / Male or Female Permanent address Street Town State Zip Code PHONE (HOME) (CELL) Skype Account College or other address Street Town State Zip Code Are you either a United States Citizen or authorized to work in the United States? YES NO Position applying for: (if more than one, indicate 1 st, 2 nd. 3 rd preference) Activity Instructor of: Team Building/Low Ropes Rocketry Boating Swimming/Life Guarding Archery Arts and Crafts Basketry Jewelry Environmental Education Outpost Camping Outdoor Cooking Support Staff Boys Cabin Coordinator Girls Cabin Coordinator Waterfront Director Chef Assistant Cook Kitchen Support Store and RN LPN EMT Recreational Games Athletics Basket Ball Ultimate Frisbee Lacrosse Tennis Performing Arts Dance Music Theater Drama Improv Musical Instruments Trail Bicycle Riding Horseback Program Director Horse Camp Staff English Western Horse Care

3 Certifications List the expiration date and the state certified. Attach a photocopy of all current certifications and send to the office copies of any additional certifications upon completion of the course. ARC Lifeguarding ARC Waterfront Lifeguarding Water Safety Instructor Standard First Aid ARC Small Craft Instructor Archery Instructor CPR Wilderness First Responder EMT or RTE (circle one) Licensed driver Low ropes facilitator Horse Safety RN LPN Nurse Practitioner Other certifications please list Serve Safe/ Have you ever been subject to professional disciplinary action or had a registration, license or certification denied, suspended, or revoked either temporarily or permanently? Yes No If yes, explain in detail on a separate sheet. Skills Assessment Please place a T next to those which you can TEACH to a group of children, mark an A for those which you can ASSIST someone teaching this skill, and an X for those which you have an INTEREST. (Health Care and Food Service can skip this section.) Arts and Crafts Sports Nature/Environmental Science Ropes Course Sketching Archery Animals Low ropes Weaving Volleyball Astronomy Facilitation Beading Basketball Birds Games Ceramics Aerobics Flowers Other Knitting Lacross Insects Painting Trail Bike riding Pond Study Dramatics Basketry Rocketry Trees/Plants Story Telling Nature crafts Fitness Eco systems Theater Jewelry Yoga Recycling Improv Other Other Other Other Literacy Outdoor Living Skills Music/Dance Horse Creative Writing Backpacking Singing Animal Care Poetry Hiking Song Writing Riding Reading Orienteering Instrument English Newspaper Outdoor cooking Jazz Dance Western Low impact camping Modern dance Barn care Camp craft Other Other Other Other Waterfront Fashion Miscellaneous Swimming Sewing Driver Canoeing Design Carpentry Kayaking Grounds keeping Other Other Other List your 3 strongest skills below, providing details of teaching, lesson planning and personal experience: Skill 1: Do you feel that you could: Teach Lead/Assist Skill 2: Do you feel that you could: Teach Lead/Assist Skill 3: Do you feel that you could: Teach Lead/Assist Rate your swimming skills: Excellent Good Fair Non Swimmer

4 Please answer the following questions. You may use an additional page for the answers. What previous experiences and skills do you possess that make you a strong candidate for a Staff Member position at Hartford County 4-H Camp? What will you give of yourself this season to make our camper s summer a positive experience? Specifically, what will you bring to HC4H camp? What are the essential elements to a well-run camp? How do you fit in? EMPLOYMENT HISTORY (List your current or last employer first.) 1. Name of employer Employer s address Employer s phone # Supervisor s name Title/position you held Dates employed Reason for leaving 2. Name of employer Employer s address Employer s phone # Supervisor s name Title/position you held Dates employed Reason for leaving EDUCATIONAL BACKGROUND (List your current or last institution first.) 1. Name of institution Location of institution Number of years completed Degrees earned Major Minor 2. Name of institution Location of institution Number of years completed Degrees earned Major Minor Do you have prior criminal convictions? YES NO Are there current criminal charges pending against you? YES NO Hartford County 4-H Camp Inc. is a SMOKE-FREE & ALCOHOL/DRUG FREE CAMP Do you agree to abide by our policy with the understanding that failure to do so will result in your termination? YES Signature of applicant References (Provide references that have firsthand knowledge directly related to your qualifications for the position in which you are applying.)

5 Statement of Application Working at HC4H Camp demands of you an unselfish attitude, sense of humor, a high energy level and a genuine concern for the positive development of children. Your concerns and efforts must always be directed toward the physical and psychological welfare of campers. Though the management at HC4-H Camp is very supportive, it is important that you recognize that working as a camp staff member is a responsible job requiring a high level of care and commitment. I understand that the hours are long with limited time to one s self and that my first priority is that of working with the campers and Teen Counselors providing them a safe and healthy experience. When are you available for an interview? (We can do interviews in person in South Windsor, CT or by Skype) Are you either a Unites States Citizen OR authorized to work in the Unites States? As of June 1, 2016, are you 18 years old or older? As of June 1, 2016, are you 21 years old or older? IF HIRED, I UNDERSTAND THAT I MUST ATTEND THE STAFF TRAINING, WHICH BEGINS JUNE 16, 2016, AND THAT I MUST BE AVAILABLE 24 HOURS A DAY, EXCLUDING APPROVED TIME OFF AS OUTLINED IN THE JOB DESCRIPTION, UNTIL AUGUST 20, I FURTHER CERTIFY THAT THERE ARE NO MISREPRESENTATIONS, OMISSIONS, OR FALSIFICATIONS IN THE STATEMENTS AND ANSWERS PROVIDED ON THE APPLICATION, AND THAT THE ANSWERS ARE TRUE, COMPLETE, AND ACCURATE TO THE BEST OF MY KNOWLEDGE. Signature of Applicant Date Signed I AUTHORIZE HARTFORD COUNTY 4-H CAMP TO CONTACT ANY OF THE EDUCATORS, EMPLOYERS, AND REFERENCES LISTED ON THIS APPLICATION, AND AUTHORIZE SUCH EDUCATORS, EMPLOYERS, AND REFERENCES TO RELEASE TO HARTFORD COUNTY 4-H CAMP ANY AND ALL INFORMATION (INCLUDING DOCUMENTS AND/OR OTHER RECORDS) REGARDING MY EDUCATION, EMPLOYMENT HISTORY, OR OTHER MATTER RELATED TO MY APPLICATION FOR EMPLOYMENT WITH HARTFORD COUNTY 4-H CAMP. Signature of Applicant Date Signed **All statements become part of any future employee files. Hartford County 4-H Camp is an Equal Opportunity Employer that hires and promotes without regard to race, color, religion, age, sex, marital status, national origin, ancestry, sexual orientation, physical or mental disabilities, including disabilities, mental retardation, and past/present history of mental disorder, or any other protected class.** RETURN COMPLETED APPLICATION WITH PHOTOCOPIES OF LICENSES/CERTIFICATIONS, AND/ANY OTHER PERTINENT DOCUMENTS RELATIVE TO THE POSITION APPLIED FOR TO: Hartford County 4-H Camp, Inc. C/O Elsie Woolam 1225 Main Street, South Windsor, CT To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, Stop Code 9419, 140 Independence Ave, SW, Washington, DC or call at least 14 days before any scheduled event if special accommodations are needed.