Location: New York,NY, USA
* **Personal Information**
* Name* First Middle Last
* Preferred Name*
* Cell Phone*
* Date of Birth* Date Format: MM slash DD slash YYYY
* Address* Street Address Address Line 2 City State ZIP Code
* Home Phone*
* Email Address*
* **Position Applying for:**
* *
+ Yes
+ No
* *
* **Certifications:**
* CPR
+ CPR
* CPR Expires
* ServSafe
+ ServSafe
* ServSafe Expires
* Basic First Aid
+ Basic First Aid
* Basic First Aid Expires
* Lifeguard
+ Lifeguard
* Lifeguard Expires
* Water Safety Instruction
+ Water Safety Instruction
* Water Safety Instruction Expires
* Wilderness CPR
+ Wilderness CPR
* Wilderness CPR Expires
* **Legal Violations:**
+ Yes
+ No
* If yes, please explain:
* **Employment History**
Please List up to three past employers, assignments or volunteer activities, starting with the most recent.
* **Employer #1**
* Company Name:*
* Phone*
* Supervisor*
* Dates of Employment*
* Work Performed*
* Address* Street Address Address Line 2 City State ZIP Code
* **Employer #2**
* Company Name:
* Phone
* Supervisor
* Dates of Employment
* Work Performed
* Address Street Address Address Line 2 City State ZIP Code
* **Employer #3**
* Company Name:
* Phone
* Supervisor
* Dates of Employment
* Work Performed
* Address Street Address Address Line 2 City State ZIP Code
* **If previously employed by another summer camp, please provide the following information:**
* Camps & Locations
* Position(s):
* Date(s):
* **Please provide two personal references:**
* **Reference #1**
* Name*
* Cell Phone*
* *
* Email*
* **Reference #2**
* Name*
* Cell Phone*
* *
* Email*
* **Verification:**
I hereby authorize Mirror Lake Retreat to contact all prior employers and any references provided here in the hiring process to verify all information related to my character and past work performance. I further hereby release all references and prior employers from any liability for information provided in good faith. I hereby affirm and acknowledge, by signing below that all of the information in this employment application is true and complete. If I move forward in the hiring process, I agree to sign a release form to have a background check run on my background.
I further understand that if I am offered a position at Mirror Lake Retreat, I will carefully read the Mirror Lake Retreat Staff Policy Manual and agree to follow these policies fully during my time on staff at MLR. I understand that if hired I will be committing myself to a position of service and that my actions should reflect my willingness to serve.
* Applicant's Signature*
* Date* Date Format: MM slash DD slash YYYY
* Enter your Name*
* Parent/Guardian Signature (if under 18):
* Date Date Format: MM slash DD slash YYYY