Caprock Council

2567 74th Street
Lubbock, Texas 79423
(806) 745-2855 (800) 530-4957
FAX: (806) 748-0769

Camp Staff Application

Preferred Camp Location:

Stevens Ranch (Residential)	Camp Timberlake (Residential)
G.S. Camp Kiwanis (Residential)	Camp Rio Blanco (Residential)
Summer Adventure Camp At Camp Timberlake (Day Camp)

Personal Information:

Name:
Present Address:
	City:	State Zip
Present Phone Number:
Permanent Address:
	City:	State Zip
Permanent Phone Number:
E-mail Address:
Present Occupation or Year in School:
Are you a current member of Girl Scouts of the USA?		Yes No
Please list any languages other than English that you can read or speak:
DATES AVAILABLE FOR CAMP EMPLOYMENT: MM/DD/YY		FROM: / /
		TO: / /
How did you learn about our camp staff positions?
Referred by a friend		Advertisement
college placement service/camp staff recruitment fair		Other:

Position Applying for: (minimum Age Requirement)

Positions vary at different camps. Please refer to Position Listings for more information.

Please rank your top three (3) choices by entering a 1 for your first choice, 2 for second, and 3 for third.

Unit Leader (18)	Program Director (19)
Camp Director (21)	Program Specialist (18)
Assistant Camp Director (21)	Health Supervisor (Nurse/EMT) (21)
Aquatics Director (21)	Riding Director (21)
Counselor (18)	Assistant Riding Director (18)
Barn Staff (18)	Wrangler (16)
Business Manager (25)	Lifeguard (18)
Kitchen Aide (16)

Education:

School Name	Dates	Major	Degree or Credits

List major study and specific courses related to position desired:

Employment Experience:

List most recent experience first: Include all camp staff experience.

Employer Name:		Address:
Dates Employed:		Reason for Leaving:
Supervisor's Name:		Supervisor's Phone / Email:
May we contact this employer for a reference? Yes No
Employer Name:		Address:
Dates Employed:		Reason for Leaving:
Supervisor's Name:		Supervisor's Phone / Email:
May we contact this employer for a reference? Yes No
Employer Name:		Address:
Dates Employed:		Reason for Leaving:
Supervisor's Name:		Supervisor's Phone / Email:
May we contact this employer for a reference? Yes No
Employer Name:		Address:
Dates Employed:		Reason for Leaving:
Supervisor's Name:		Supervisor's Phone / Email:
May we contact this employer for a reference? Yes No

Areas of Interest

Mark areas in which you have:

1. An interest but little experience
2. Experience and can assist in teaching
3. Training/knowledge and can teach

Camping Skills
Camp Craft
Primitive Camping
Outdoor Cooking
Backpacking
Firebuilding
Orienteering
Sports
Softball
Volleyball
Group Games
Bicycling
Fishing
Horseback
Archery
Soccer
Water Polo
Aquatics
Swimming
Sailing
Canoeing
Water Games
Synch. Swim
Diving
Scuba/Snorkel
Dramatics
Acting
Script Writing
Skits and Stunts
Music
Play instrument
Song Leading

Creative Arts
Painting
Leatherwork
Weaving
Woodworking
Photography
Journalism
Scrapbooking
Ceramics
Collages
Nature and Ecology
Astronomy
Geology
Botany
Birds
Insects
Weather
Trails
Environmental Ed.
O.B.I.S.
Dancing
Folk
Interpretive
Modern
Square
Other

Training and Skills:

Courses taken in Leadership or Skill Development	Agency	Place	Dates

Certifications:

Certification	Exp. Date	Certification	Exp. Date
Ropes Course		ARC First Aider
ARC Lifeguard Training		Standard or Multi Media
ARC Waterfront Lifeguarding Module		Advanced
ARC Water Safety Instructor		CPR
ARC Canoe Instructor		Level Agency
ARC Sailing Instructor		EMT, State:
ARC Basic Canoeing		Registered Nurse State:
ARC Basic Sailing		Licensed Driver
ARC Basic Kayaking		DL #
NAA Archery Instructor		State
ACA Outdoor Living Skills		Other:
CHA Horseback Riding Instructor

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

If yes, please state offense, date and location: (A conviction record will not necessarily be cause for disqualification.) The council will conduct a criminal and sex offender background check on every employee.

Activities

Briefly describe community, school or other experiences that will enable you to carry out the responsibilities of the job you are seeking. Also, describe experience in working with children.

Experience as a Camper/Staff

Briefly describe any camping experience (group, family, etc.)

Personal Philosophy

What specific qualities about yourself do you feel will make you a positive addition to our staff?

What personal qualities do you have that make you a positive role model for girls and young women?

What are your strengths?

Where do feel you need improvement?

What do you feel parents expect of you, in caring for their children?

Camp is a community where the people live, play and eat together. As a staff member, you must be willing to totally immerse yourself in this close-knit environment. The demands will be both physical and emotional. In what ways are you prepared for this challenge?

How do feel about snakes, bugs, the dark and the heat?

The tone you set is important. What are some things that are inappropriate at camp? (i.e. language, attitude, etc.)

How can you make sure that each camper under your care feels that she is important?

How can you avoid playing favorites?

How can you help your campers grow in personality and character so they have high self-esteem?

Are there specific age groups you prefer to work with?

Please give your reasons:

Describe some experiences you have had working with children.

Additional Comments

References:

List the names of three persons (such as former employers, teachers, or religious leaders) not related to you to whom you have furnished reference forms. If you have previous experience as a camp staff member, at least one reference should be from a camp director or administrator.

Name	Address / City / State / Zip	Phone	Position