Outdoor summer camp - Pierce Camp Birchmont in Wolfeboro, NH

Name

Dates

Degree/Major

Professional

University

High School

Please explain any gaps in you education history:

Name & Address of Employer

Dates

Position

Please explain any gaps in you employment history:

Indicate any employer you do not wish us to contact, and the reason:

Name & Address
of Camp/School

Dates

Responsibilities
or Job Title

Name/Title

Address

Phone #

Certifications and Camp Support Staff Skills In the following list, please select "Skilled" for those items in which you have experience and skills. Select "Certified" for those which you hold current certification and send a copy of your certification.

At Birchmont we try to hire people who will make a difference:
Write a brief biographical sketch, include any specialized training or related experience
that may have a bearing on the position(s) for which you are applying:

Please list any relevant and up to date certifications you may have
(For example:Lifeguard Certified, First Aid, etc...)

Harassment The camp's policy is to prohibit all forms of harassment by our employees.
This includes sexual, racial, religious, and other forms of harassment. Have you ever
been accused of harassment of any person including, but not limited to, workplace harassment?
(Note: a prior accusation or conviction is not an automatic bar to employment.
The type of conviction or accusation and when it occurred will be evaluated by
the camp before any decision is made)
Explain:

Criminal Record Have you ever been convicted of a crime, other than a minor traffic offense? If yes please describe.(Note: a prior conviction is not an automatic bar to employment. The type of conviction or accusation and when it occurred will be evaluated by the camp before any decision is made)
Explain:

I authorize investigatin of all statements herein, including any checks of criminal records, and release the camp and all others from libility in connection with same. I understand that, if employed, I will be an at-will employee unless there is an agreement or law which alters that status. Furthermore, I understand that any agreement must be in writing and signed by the designated camp official. I also understand that untrue, misleading, or omitted information herein or in other documents completed by the aplicant may result in dismissal, regardless of the time of discovery by the camp.