2021 Job Application Valley Mill Job Application Name* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Phone*Email* Date of Birth* Date Format: MM slash DD slash YYYY If Under 18, Name of Parent or Guardian First Last Phone# of Parent or GuardianEmail of Parent or Guardian How long at current address?*Previous addresses (10 years)*Do you have a valid Drivers License?*YesNoDo you have a valid Commercial Drivers License?*YesNoAre you a US citizen, or do you have the right to work in the US?*YesNoAre there any reasons you may have difficulty performing the essential functions of the job you are applying for?*YesNoIf Yes, Please explainValley Mill is a drug free, smoke free workplace, we drug test all of our employees randomly. I can comply to a drug free and smoke free environment*YesNoHave you ever been convicted or charged with any crime including sex related or child abuse offences?*YesNoIf "Yes", please explain.EducationName of High School*Dates Attended*Graduated?*YesNoName of College/UniversityDates AttendedDegree Earned?YesNoOther Education Program or CertificationsHave you ever served in the Military?*YesNoIf Yes, what is your discharge status?Adventure Sports SkillsIn the following list check only those activities you can organize and teach.Rock Climbing Can Assist Can Teach Certified Kayaking Can Assist Can Teach Certified Canoeing Can Assist Can Teach Certified First Aid SkillsWilderness First AidCertifiedInstructorEMTCertifiedInstructorLifeguardCertifiedInstructorCamp Activity SkillsHorseback RidingCan AssistCan TeachCertifiedArcheryCan AssistCan TeachCertifiedAir RifleCan AssistCan TeachCertifiedSoccerCan AssistCan TeachCertifiedSwimmingCan AssistCan TeachCertifiedSynchronized SwimmingCan AssistCan TeachCertifiedDramaCan AssistCan TeachCertifiedArts & CraftsCan AssistCan TeachCertifiedBasketballCan AssistCan TeachCertifiedGymnasticsCan AssistCan TeachCertifiedPioneering/Camping SkillsCan AssistCan TeachCerifiedMaintenance SkillsFor the following indicate your skill level, 1 being Inexperienced to 5 being ExpertAutomotive12345Carpentry12345PlacementWhat position are applying for at Camp?*What department do you see yourself working in?* Boys Camp Girls Camp Junior Camp (4-5 Year-Olds) Maintenance Office What contributions do you see yourself making to Valley Mill Camp?*I am available Orientation Week (6/6 - 6/12)*YesNoI am available Nine Weeks of Camp (6/15 - 8/14)*YesNoI am available Tenth Week of Camp (8/17 - 8/21)*YesNoI have the following conflicts with the dates above:*Work ExperienceCompany 1Job TitleDates WorkedPay RateSupervisorContact InfoCompany 2Job TileDates WorkedPay RateSupervisorContact InfoPersonal ReferencesPlease Provide Three References (Non-Family)Reference 1* First Last PhoneEmail Reference 2* First Last PhoneEmail Reference 3* First Last PhoneEmail TransportationValley Mill Camp provides transportation to it's Campers, and may be able to extend this to employees - would you like ride the bus to and from Camp?*YesNoReferralIf you were referred to Valley Mill Camp by a current Valley Mill Camp Employee, enter that person's name here.SignatureBy entering my name below, I certify that all answers given are correct and true to the best of my knowledge, and understand that false information can lead to rejection of this application, or termination of employment. Name* First Last