Use this form to apply for a position with our company. Please enter all information requested. Contact InformationName* First Last Email* Cell Phone*Additional PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Personal InformationDate of Birth* Position Applying For*Camp Counselor/Jr. CounselorCamp Lead InstructorCamp DirectorAfter School InstructorTechnology ExpertWhy do you feel that you would be a good fit for the position you are applying for?*Education InformationEducation Status*Current High School StudentCurrently in CollegeNot in College, WorkingCollege GraduateCertified TeacherCollege Attended (if applicable)Undergrad Major (if applicable)Year you graduated/will graduate college (if applicable)Credentialed Teacher?*YesNoDo you have CPR Certification?*YesNoFirst Aid Certificate?*YesNoWork and Camp HistoryPlease give a brief description of your work experience relevant to the position you are applying. You may paste work history from your resume.*Describe an experience in which you were either part of or led a successful team. Describe the situation,the actions you took and the results. (max 200 words)*Describe an unforgettable teaching experience you have had with a child. (Max 200 words)*If you were a counselor, lead instructor or director of a summer camp, what would your philosophy be? (Max 200 words)*Professional ReferencesFor references, please provide TWO PROFESSIONAL REFERENCES. **Professional references are supervisors, managers, teachers, coaches, mentors, pastors, etc. Please do NOT use family members, co-workers, and friends. **We only contact references by email, so you MUST include their email addresses. List 2 professional references, at least one of which is a recent supervisor in a position relevant to this position:*NameRelationship to YouEmail AddressTelephone Number General InformationWho do you know who might be interested in learning more about Club SciKidz employment opportunities?Have you applied for a position with our company before?*YesNoHow did you hear about this employment opportunity?*If you were referred by someone, list them here:Have you ever been convicted of a felony or misdemeanor?*YesNoHave you ever been involved in an incident involving sexual or physical abuse of a child?*YesNoDo you have any thoughts/comments about your preferred location? Please go to our website for after school or summer camp location preferences.*Do you have any physical conditions or diseases that would affect your abilities to perform all camp and classroom duties?*YesNoIf yes, please explain:What is your availability? (days & times)*Certification and ReleaseTo the best of my knowledge and belief, the information given truly represents my background and experience. I understand that if I have knowingly or negligently misrepresented, falsified or omitted any information during the application process, I may be disqualified for employment consideration or dismissed from employment with Club SciKidz.* I agree to allow Club SciKidz to do a background check. CommentsQuestion or CommentsNameThis field is for validation purposes and should be left unchanged.