Staff Application

Personal Info

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Gender *

Male Female

Birthday (MM/DD/YYYY) *

Scouting Background

Current Unit Number: *

Years in Scouting *

Rank obtained as a Scout *

Past Unit Positions *

Council *

Current Unit Position *

Order of the Arrow *

No Ordeal Brotherhood Vigil

Camp Background

Years at Camp as a Scout *

Years at Camp as Staff *

Past Staff Positions and Years *

Years at Camp as an Adult Leader *

Were you a CSD? *

Yes No

List any specialized training/certifications: *

Character and community

What Church, School and Community activities are you involved in? *

What are your hobbies? *

How has Scouting benefited your life? *

What awards and recognitions have you recieved? *

What areas of Scouting do you like best? *

Staff placement

Your Top 3 Desired Positions at Camp *

What areas at Camp do you feel most qualified to instruct? Why? *

Why do you want to work Kia Kima Staff? *

What Merit Badges have you earned that are relevant to the summer camp program? *

Is there anything else you would like to tell us? *

References

Please include contact information for both your references. (Address, Phone Number, Email)

Reference #1 *

Reference #2 *

Dates Available this Summer: *

Please review this application carefully to affirm that the information is correct, to the best of your knowledge. In signing this application, you attest that the information given is true. You also agree to forfeit the right to view your employment file concerning reference information, in order to protect all parties involved. Once again, please read this application carefully before signing.

Signature (Your name as you would sign it) *