Courage Camps, where abilities and disabilities, become possibilities.
"Where abilities and disabilities become possibilities"

Application for Employment

This personal history statement is used in the recruitment and employment of staff members for Courage Camps. Please complete this entire application as it is necessary as a bonafide occupational qualification in determining staffing and housing arrangements. Courage Center is an equal opportunity employer and welcomes all qualified applicants without regard for age, sex, race, creed or disability.All employees must be able to show proof of eligibility to work in the United States.

Campus
Please specify the campus/campuses that you are applying to (leave blank if unsure):
Camp Courage
8046 83rd St. NW
Maple Lake, MN 55358 		Courage North
Box 1626
Lake George, MN 56548 		Courage Day Camp
8046 83rd St. NW
Maple Lake, MN 55358
Select Campus:
General Information
First Name:
Middle Name:
Last Name:
   
Current Address:
City:
State:
Zip:
Country:
Home Phone:
Email Address:
Position Applying For:  
How did you hear about us? (friend, search engine, website, etc.)
Emergency Notification
Emergency Contact Name:
Relationship to you:
Day Phone (include Area Code):
Evening Phone:
Education
Please list the most recent first.

College/School 1:
Dates/Years Attended:
Major:
Degree:
   
College/School 2:
Dates/Years Attended:
Major:
Degree:
   
College/School 3:
Dates/Years Attended:
Major:
Degree:
Abilities and Skills
We need an honest evaluation. Please do not underrate or overrate your abilities.

1 = Personal ability (ability to assist or do personally)
2 = Leadership ability (ability to prepare, teach, or lead on your own)
3 = Past leadership experience or have taught skill
Communication: Please indicate method(s) of communication used by the applicant. Add details to the right and any other skills below.
Archery of Riflery: No Experience   1   2   3  Additional Info:
Arts and Crafts: No Experience   1   2   3  Additional Info:
Backpacking: No Experience   1   2   3  Additional Info:
Bike Tripping: No Experience   1   2   3  Additional Info:
Canoeing: No Experience   1   2   3  Additional Info:
Computer Skills: No Experience   1   2   3  Additional Info:
Drama: No Experience   1   2   3  Additional Info:
Field & Gym Recreation: No Experience   1   2   3  Additional Info:
Fishing: No Experience   1   2   3  Additional Info:
Horseback Riding: No Experience   1   2   3  Additional Info:
Musical Background: No Experience   1   2   3  Additional Info:
Nature Studies/Environmental Ed.: No Experience   1   2   3  Additional Info:
Photography/Darkroom Process: No Experience   1   2   3  Additional Info:
Pontooning/Small Engine Boating: No Experience   1   2   3  Additional Info:
Sailing: No Experience   1   2   3  Additional Info:
Sign Language: No Experience   1   2   3  Additional Info:
Swimming: No Experience   1   2   3  Additional Info:
Tennis: No Experience   1   2   3  Additional Info:
Tent Camping : No Experience   1   2   3  Additional Info:
Wheelchair Basketball: No Experience   1   2   3  Additional Info:
Other: No Experience   1   2   3  Additional Info:
Other: No Experience   1   2   3  Additional Info:
   
Current Certifications: Lifeguard Certification  Dates:
  W.S.I.  Dates:
  C.P.R.   Dates:
  First Aid   Dates:
  Other Certifications (Please List):

Please list any other experience or skills you have that would be of benefit to camp:
 
Work Experience
Please list the most recent first.

Employer 1: Position:     
Supervisor Name:  Day Phone:  Start/End Dates: 
           
Employer 2: Position:     
Supervisor Name:  Day Phone:  Start/End Dates: 
           
Employer 3: Position:     
Supervisor Name:  Day Phone:  Start/End Dates: 
References
Please do not list relatives. Employment references are preferred.
Reference 1:      
Name: Occupation:
Address: City: State: Zip:
Day Phone (include area Code): Evening Phone:  Email:
       
Reference 2:      
Name: Occupation:
Address: City: State: Zip:
Day Phone (include area Code): Evening Phone:  Email:
Background Information
Have you been conficted of a crime within the last five years?     No   Yes
If yes, briefly describe circumstances, including date of conviction, nature and place of offense, and disposition of case. This information is viewed as only one factor in your consideration of employment and is evaluated in terms of nature, severity, and date of offense. Do not include arrests without convictions.

Description:
Application Verification
All applicants must complete this section.
  • Any material misrepresentations or deliberate omission of a fact in my application may be justification for refusal of, or if employed, termination of employment.
  • I hereby authorize investigation of all statements contained in this application and any attached résumé, and agree that if any misrepresentation or omission has been made by me herein or the results of an investigation are not satisfactory for any resason, any offer of employment made to me by Courage Center may be terminated immediately without any obligation or liability to me other than for payment, at the rate agreed upon, for services actually rendered if I have been employed.
  • I hereby authorize any person(s) or concern, except as provided above, including former employers, to furnish any and all information, including personal character, habits, work record and skills, or any other pertinent information in their possession without liability or exposure to damages whatsoever on account of having furnished such information.
  • I hereby certify that the statements made in this application are, to the best of my knowledge, completely true and correct.
  • I understand that I must print, complete and submit Courage Camps Reference Form(s).
I have read and agree to the above statements: No  Yes

© 2007 Courage Camps