APPLICATION FOR EMPLOYMENT             

 Name ________________________________________   Date ___________________

Birth Date __________________ Social Sec. # ______-_____-______ U.S. Citizen? Yes   No

Mailing Address _____________________________ City ____________________ Zip ______

Phone _________________Cell Phone __________________ E-mail ____________________

Education:  Level Completed:  ____________    School Name ____________________  

        City/State : ______________________

Describe post high school education: _________________________________________________________

Position applying for: ____________________________________ 

 Dates available: ___________________

Describe previous experience qualifying you for this position: 

_______________________________________________________________________________________

_______________________________________________________________________________________

What contributions can you make at Camp Indianola ? 

 _____________________________________________________________________________________

 _____________________________________________________________________________________

 Are there any reasons you may have difficulty in performing any of the functions of this job? 

 ____________________________________________________________________________________

PERSONAL REFERENCES:  Give names, addresses and phone numbers of 3 people (not relatives).

1. _________________________________________________________________________

2. _________________________________________________________________________

3. _________________________________________________________________________

PREVIOUS EMPLOYMENT:  List last 3 positions.  

1.  Employer _____________________________________ Phone ___________________

Address ____________________________ City _________________ ST ______ Zip _______

Starting Date ____________ Ending Date ____________ Supervisor _______________________

Responsibilities __________________________________________________________________

Why did you leave this job?  ________________________________________________________

2.  Employer _____________________________________ Phone _________________

Address ____________________________ City _________________ ST ______ Zip _______

Starting Date ____________ Ending Date ____________ Supervisor _______________________

Responsibilities __________________________________________________________________

Why did you leave this job?  ________________________________________________________

3.  Employer ___________________________________________________ Phone _________________

Address ____________________________ City _________________ ST ______ Zip _______

Starting Date ____________ Ending Date ____________ Supervisor _______________________

Responsibilities __________________________________________________________________

Why did you leave this job?  ________________________________________________________

Do you have a valid driver’s license? ______    State _____   License # ____________________

I authorize investigation of all statements herein and release the camp and all others from liability in connection with same.  I understand that, if employed, I will be an at-will employee and that any agreement to the contrary must be in writing and signed by the director of the camp.  I also understand that untrue, misleading, or omitted information herein may result in dismissal, regardless of the time of discovery by the camp.

Signature __________________________________________________                            

Send completed application to:  

Camp Indianola

P.O. Box 1150

Indianola, WA  98342

office@campindianola.org  www.campindianola.org  (360)297-2223

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