EmailMe Form - GSRP 2013 Staff Application Form

First Name: *

Last Name: *

Address: *

City: *

State: *

Zip Code: *

Cell Phone: *

Home Phone:

Email Address: *

Confirm Email Address: *

Date of Birth:
*You must be 16 before June 15, 2013 to apply. *

Select Your Educational Background: *

Reference #1 Name: *

Reference #1 Contact Number: *

How do you know Reference #1? *

Reference #2 Name: *

Reference #2 Contact Number: *

How do you know Reference #2? *

Reference #3 Name: *

Reference #3 Contact Number: *

How do you know Reference #3? *

Have you worked at the Groveland Summer Recreation before? *

Do you have a CURRENT CPR/First Aid Certification? *

If you are not currently certified in CPR/First Aid, would you be willing to get certified?

What position are you applying for?

If you are applying for a counselor position, which age group would you prefer working with?

First - Third Grade

Fourth - Fifth Grade

Sixth - Seventh Grade

Why? *

If you do not have an age preference, explain why as well.

What experience do you have working with children? Be specific. *

List any personal schedule conflicts you have between June 15 - August 15, 2013: *

DISCUSS one example of when you acted as a positive role model for BOTH children and your peers AND a negative role model for both children and your peers. *

List 3 Personal Stengths: *

List 3 Personal Weaknesses: *

What is your T-Shirt size? *

For staff uniform ordering purposes, if you are hired.

Staff Signature: *

By typing in your first and last name, you certify that the above information is accurate and correct and you have never been convicted of any crime. Please be advised that all staff of the Groveland Summer Recreation Program MUST pass a criminal background check that is conducted by the Town of Groveland and the Commonwealth of Massachusetts.

Today's Date: *

MM / DD / YYYY