Returning Staff Application

Contact Information

First Name

Last Name

Current Mailing Address

City

State

Zip

Phone

College

Major

YR in School

Religious Faith

Active?

Yes No Occasionally

Current Employer

Full-Time Part-Time Work Study

Company

Title/Position

Supervisor

Work Phone

Address

City

State

Zip

2012 Summer Information

What sessions are you available next summer?

Father/Son 1 (May 18-20) Father/Son 2 (May 25-27) Required Orientation (May 27-June 2) June (June 3-22) Main (June 24-July 20) August (July 22-August 3) Junior (August 5-10)

*$200.00 bonus for signed contract received by November 23, 2011 (to receive bonus you must work three or four sessions).

In order, list the activities you would like to teach and/or assist in next summer. Requests will be considered, but job assignments will be determined based upon the overall needs of camp.

What tribe would you like to be in?

Cherokee Catawba Tuscarora Iroquois

Are you interested in doing an internship project at Falling Creek Camp this coming summer?

Yes No

If yes, what is your idea for an internship?

Please list current certifications and expiration dates

Please list certifications you need recertified or would like to get

Important Guidelines

Illegal Drugs: The use of any controlled substance, including marijuana, is absolutely prohibited during your employment with Falling Creek Camp.

Tobacco: Falling Creek Camp is a tobacco free community. The use of any tobacco product is strictly prohibited on camp property or any Falling Creek Camp sponsored event / trip.

Alcohol: Consumption of alcoholic beverages by minors (under 21) while employed by Falling Creek Camp is prohibited. Absolutely NO alcoholic beverages may be brought onto camp property and no one may return to camp under the influence at any time.

Appearance: New body piercing, tattoos, and extreme hair coloring/cutting are not permitted during employment at Falling Creek. Staff will set a good example in their clothing and appearance while at camp.

Can you comply with the above policies?

Yes No

Do you use tobacco products?

Yes No Occasionally

Do you consume alcoholic beverages?

Never Seldom Weekly Daily

Have you ever been accused, arrested, prayer for judgment or convicted of a misdemeanor or felony (exclude minor traffic violations)?

Yes No

Have you ever been accused, arrested, prayer for judgment or convicted of sexual misconduct with a child or child abuse?

Yes No

If yes, please explain:

Your signature attests that you have answered all questions honestly and accurately and that you have no problem complying with the type of lifestyle indicated by the camp.

Your signature also gives permission for the camp to check references and work history.

Any untrue, misleading or omitted information herein may result in dismissal, regardless of the time of discovery by the camp.

All statements become part of any future confidential employee files. I am aware and give permission for a background check, including a criminal records check, a sex offender database check, a social networking search and driving record search.

Electronic Signature

During the summer, the camp takes photographs, slides and video footage of camp activities for use in promoting the camp. I give my permission for the camp to use any photographs, slides or video footage of me in its promotional materials.

Electronic Signature

Optional

*If you recommend a friend for staff at Falling Creek, we hire them, and they complete their contractual obligations, you receive a $150.00 bonus!

Name

Address

City

State