Rolling Hills Country Day Camp in New Jersey : Summer Staff

One way to apply to Rolling Hills Day camp is by filling out and submitting the online form below. If you would rather use a printed application, please download it here and then either fax it or mail it to us.

This application MUST be completed by the applicant, and NOT a third party (parents included).

Position Applying for: Counselor Activity Specialist Lifeguard Supervisor Other
	I am also applying for Bus Counselor: Yes No
Personal Information
First Name:		Last Name:
Date of Birth:	You must be 16 by 6/25/12 and completed 10th grade.
Gender:
Home Address:		Home Phone:
City:		Cell Phone:
State:		Email:
Zip:
Our 2012 camp dates are JUNE 25 - AUGUST 17, Mon. - Fri. from 8:45 - 4:00. Do you have any conflicts with these dates? No Yes If yes, please explain:

Are there any physical limitations/recurring illnesses which would interfere with your ability to perform the job for which you are applying? No Yes If yes, please explain:

Have you ever applied to work with us before? Yes No
If yes, what year?

Education
High School:	School:	Year of Graduation:
College:	School:	Year of Graduation:
Graduate School:	School:	Year of Graduation:

Camp Staff Experience
Dates of Employment	Name of Camp	Town and State	Position

Additional Work Experience
Dates of Employment	Employer	Supervisor's Name	Telephone	Nature of Work

References (List teachers, coaches, supervisors - NOT friends, family or neighbors)
Name	Position	Telephone

Experience as a Camper
Name of Camp	Years Attended

Skills and Interests Indicate to the right of each activity, by appropriate number, the areas below in which you have (1) Interest, (2) Experience, or (3) Teaching Knowledge
SPORTS & SWIM		ART
Lifeguard	1 2 3 N/A	Ceramics	1 2 3 N/A
Archery	1 2 3 N/A	Jewelry	1 2 3 N/A
Basketball	1 2 3 N/A	Lanyard	1 2 3 N/A
Gymnastics	1 2 3 N/A	Wood Working	1 2 3 N/A
Hockey	1 2 3 N/A	PERFORMING ARTS
Soccer	1 2 3 N/A	Dance	1 2 3 N/A
Softball	1 2 3 N/A	Drama	1 2 3 N/A
Tennis	1 2 3 N/A	Music	1 2 3 N/A
Lacrosse	1 2 3 N/A	Cheerleading	1 2 3 N/A
OUTDOOR ADVENTURE		CREATIVE
Bungee Trampoline	1 2 3 N/A	Cooking	1 2 3 N/A
Zipline	1 2 3 N/A	Digital Photography	1 2 3 N/A
Rock Wall	1 2 3 N/A	Nature	1 2 3 N/A
Ropes Course	1 2 3 N/A	Rocketry	1 2 3 N/A
Go Karts	1 2 3 N/A	Science	1 2 3 N/A
Dirt Bikes	1 2 3 N/A	Tech Wreck	1 2 3 N/A
OTHER ACTIVITIES		Model Building	1 2 3 N/A

Please indicate the grade level of campers that you prefer to work with (check all that apply)
Pre-K/K	1st-2nd grade	3rd-4th grade	5th-7th grade	8th-10th grade	Travel

How were you referred to Rolling Hills Country Day Camp? Name:

Please describe any experience working with children in schools, clubs, babysitting, etc.

Do you have any special skills? (juggling, playing guitar, singing, etc.)

List the top three reasons you want to work at Rolling Hills Day camp.

Harassment The camp's policy is to prohibit all forms of harassment by our employees. This includes sexual, racial, religious, and other froms of harassment. Have you ever been accused of harassment of any person including, but not limited to, workplace harassment? (Note: a prior accusation is not an automatic bar to employment. The type of accusation and when it occurrred will be evaluated by the camp before any decision is made.) Yes No
If yes, please explain:

Have you ever been convicted of a crime other than a traffic violation? Yes No
If yes, please explain:

By submitting this application you are giving Rolling Hills Day Camp permission to do a full background check. You are ensuring all information on this application is correct. If you are hired for a position at Camp, you understand that any false information may be cause for dismissal.