Staff Application

☟ Personal Information

*First Name

*Last Name

Middle Initial

Gender

Female
Male

Home Phone

*Home Street Address

*Home City

*State

*Zip Code

*Date of Birth

*Cell Phone

*Email Address

☟ Education

Check One

edu_1 College
edu_2 High School

Position You Are Applying For

Group Leader (current college student)
Assistant Counselor (entering freshmen year in college)
Junior Counselor (entering 11th or 12th grade)
yes_more Other (Specify)

☟ Additional Skills

Please spend some time considering the following:

What are your 3 best qualities?

Why do you want to work at Beth Sholom Day Camp?

☟ Personal References

List 3 (Teachers, Colleagues no family or friends)

	Name	Phone
1	*Name	*Phone
2	*Name	*Phone
3	*Name	*Phone

*HAVE YOU EVER BEEN ARRESTED OR CHARGED WITH ANY MISDEMEANOR OR FELONY?

yes_more Yes
No

Please review the above application before clicking the Submit button. Submitting this form will serve as your acknowledgment that the above information is correct.

*Yes, I agree to allow Beth Sholom Day Camp to do a background check and I affirm that all the above information is true to the best of my knowledge.

Required