Dates of Camp are July 2nd to August 16th 2012.
For mandatory training dates click here

Applicant’s name:

First Last

Nickname

Home address:

Gender

Male Female

Marital Status

Single Married Divorced Widowed

Home Phone #:

Work Phone #

Cell Phone #:

E-mail address:

Will you be at least 18 years old before the start of camp?
No Yes  
If no, please provide the following:

Mother’s Cell #   
Mother’s Work #
Father’s Cell #    
Father’s Work # 

Would you like to work pre-camp to help set up?   If yes earliest date available

T-Shirt Size Required

Small Medium Large X Large XX Large XXX Large

Are there any health concerns, allergies or medications that you would like us to be aware of? Yes No If yes, please describe

Camp Dates for 2012: July 2nd-August 16th (Staff training / orientation takes place during the week of June 24) Do you have any conflicts with these dates? No Yes If yes, please explain.

Please note: A rehire interview by telephone is required. You will be contacted once we receive this application.

What was your position with Harbor Haven last summer?

Are you applying for the same position?

Yes No

Position You are applying for (select all for which you would like consideration):

Junior counselor (high school students)
Preferred age group: 3-5   6-7   8-9   any age group

General Counselor (undergraduate college students and college graduates)
Preferred age group: 3-5   6-7   8-9   10-11  12-15   any age group

Specialist (College graduates or graduate students with knowledge and skills in one of the following areas are hired as specialists. Please check any areas you feel you could lead) sports;  arts & crafts;  music;  nature/science; dance;
 drama;  cooking;  computers;  photography;  bicycle riding;  tennis;
 initiative/team building activities;  life/job skills

Academic Specialist (must be certified special education teacher in the State of New Jersey)

Social Skills Specialist (Must have appropriate certification to run social skills groups with children. Social worker, learning consultant, psychologist, guidance counselor or professional counselor are some examples of professionals that qualify.)

Assistant Supervisor (college graduate with relevant experience)

Supervisor (Education degree preferred or relevant degree. Must have experience working with special needs children)

Occupational Therapist (degree in OT; proper licensure and certification required)

Speech Therapist (degree in Speech Therapy; proper licensure and certification required)

Not Sure (will discuss if an interview is granted)

Please list any additional course work or experience you have had since last summer that would be relevant to the position for which you are applying.

Please Check all that apply: I am a full time student ; I am a part-time Student
                                         I am employed full time  ; I am employed part-time

Please describe your thoughts about the experience you had at Harbor Haven last summer. Be sure to include improvements that you would like to make in your performance for the summer of 2011.

^{High School}

^College

^{Graduate School}

^Institution

^Major/Minor

^Degree

^{Year of Graduation}

^{Current Year}

^{N/A Freshman Sophomore Junior Senior}

^{N/A Freshman Sophomore Junior Senior}

^{N/A 1 2 3 4 5 Graduated}

Do you have a teaching degree? No Yes If yes, Please indicate the type of certification you have:

State

Date issued

Reference: Please list one additional (new) reference since last summer. It should not be a friend, relative or neighbor.

Name of Reference

School/Company/Organization.

Relationship

Phone #

Work History: Please list your current employment (If applicable)

 If applicable, What type of job do you currently have?                                

Name of Employer

Address of Employer

Phone # of Employer

Supervisor’s Tel #

Staff may be required to be a bus/van counselor, if needed. There is additional salary for this. Are you willing to be a bus counselor if needed? No Yes If no, please explain

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

Please check any certifications you may have and list their expiration dates. Please send a copy of your certifications-back & front-in the mail.

Certification

Date Issued

Expiration Date

WSI

Lifeguard

CPR

First Aid

RTE

EMT

AED

Epi-Pen

RN

Other (Pls Specify)

Please read the following carefully.
1.  By checking this box , I am giving authorization to Harbor Haven to do a full background search and reference check.
2.  By checking this box , I certify that all the statements and information in this application are accurate and complete, and I understand that any employment offer is based upon the accuracy of this information. If I am hired for a position at Harbor Haven, I understand that any false statements, omissions or inaccuracies of this application may be cause for dismissal. Please insert today’s Date: and write your full name: