Camp Pinewood - Hendersonville, NC

Camp Pinewood

Staff Application

Please Note: Before submitting this application, please be certain that you are in accord with the same standards that our campers must comply with.

Smoking or the use of tobacco products is not permissible on camp grounds.
Eccentric hair styles / sideburns, including earrings, are not allowed on boys' camp.
Body piercing (other than females' ears) is not permitted.

Name

Date of Birth

Height Weight

Permanent Address (street and number)

Permanent Phone

School Residence Address

Cell Phone

Last date you can be reached at this address

E-mail address

Do you have a valid drivers license? No Yes
Have you ever been suspended from any school or university? No Yes
Have you ever received emotional counseling? No Yes
Do you smoke or chew tobacco? No Yes
Have you been involved in any physical or sexual abuse? No Yes
Do you have any tattoos? No Yes
Have you ever been convicted of a misdemeanor or felony? No Yes
Have you ever been convicted of a crime? No Yes
May we obtain a law enforcement background check? No Yes

Are there any special physical or sensory facility needs that we should know to assure meaningful participation? If yes, please describe below.

Education

Attending What College?

Major? Year completed as of June

What age children do you relate to best?

Have you ever attended a resident summer camp as a camper or counselor for one week or more?
Yes No

What type of position do you want at Pinewood?
Cabin Counselor Instructor Counselor
Other: please name *multiple choices are acceptable

Please give the earliest and latest dates you would be available: From: To:

List current certifications. (Example: CHA, First Aid, CPR, Advanced Life Saving, W.S.I..)

If applying for an instructor position which activities (in order of preference) are you most interested in supervising or teaching at Pinewood to campers age 8-14?

If it can be arranged, would you like to receive a salary draw or advance at one point during the summer?
Yes No

If you have been employed in any position that entails working with children, including regular baby-sitting positions, (A non-related adult) please complete:

Position held Name of employer

Telephone
Name of Supervisor
Dates of Employment: from to

Position held Name of employer

Telephone
Name of Supervisor
Dates of Employment: from to

Please submit information in regard to your experience in working with children and/or activity skills.

Other Employment A non-related adult

Name of Company

Name of Supervisor
Address
Phone:

Dates of Employment: from to

Character References (teachers,neighbors, guidance counselors, supervisors, etc.) A non-related adult. Important -This section must have phone numbers. These individuals can be the same as any of the references that you listed above as long as they are non-related, at least 21 years of age and have known you for 4 years or more.

1) Name Relationship to you
Area Code/Telephone

2) Name Relationship to you
Area Code/Telephone

This section is provided for further explanations, comments or questions.

By typing my name below, I confirm that the statements in this application are correct and complete. I understand that any misrepresentation or omission of information shall be considered sufficient reason for withdrawal of an offer or subsequent termination of employment. I give Camp Pinewood permission to speak with any party who can ascertain my skills and character. Applicants being considered will be contacted by telephone within one week from date application is received.

Full Name Date

Where did you find us?

**Only push submit button once.

300 Orr's Camp Road Hendersonville, NC 28792 828-692-6239	Camp Directors: Ron & Jack Levine