Merrowvista Internship Application

General Information

Please tell us a little bit about yourself.

First Name *

Middle Initial

Last Name *

Name I prefer being called

Email *

Home Phone xxx-xxx-xxxx

Cell Phone xxx-xxx-xxxx

Social Security Number

OPTIONAL: Date of Birth mm/dd/yyyy

T-Shirt Size *

Date I am able to start at Merrowvista * mm/dd/yyyy

Date I must finish at Merrowvista * mm/dd/yyyy

Have you ever been a participant in an American Youth Foundation program? YesNo

Please describe:

Have you been employed by the American Youth Foundation: YesNo

Please describe:

Are you currently 21 years of age or older or will you be by the start of the program staff position (August 22nd, 2012)? * YesNo

Select the method which best explains how you found out about this job

Please specify:

Current or College Contact Information

Mailing Address

City

State/Province

Province

ZIP Code

I will be at this address until what date? mm/dd/yyyy

Permanent or Home Contact Information

Leave this section blank if you have only one address.

Street Address

City

State

Province

ZIP Code

Telephone

Education

High School

Name

Location

Diploma Received? YesNo

College/University

Name

Location

Major

Type of Degree

Please indicate your current academic year. If you are not in school, please select the last year completed.

Other Education

Name

Location

Training Received

Employment History

Please list previous employers or provide this information on a current resume. List relevant experience first.

Resume

Please attach a current résumé with your application or paste in the field below.

You may paste your TEXT-ONLY resume here.

Or choose an attachment to upload: The file size limit is 4 MB.

Employer

Company Name

Company Address

Company Phone

From (Month/Year)

To (Month/Year)

Your Position

Supervisor's Name

Supervisor's Position

Your Duties

Reason for Leaving

May we contact this employer? *

References

Please list three references who can comment on your professional or academic work.

Reference

Name *

Organization/Position *

Telephone *

Email

Relationship *

Years Known * (Rounded to the nearest year)

Reference

Name *

Organization/Position *

Telephone *

Email

Relationship *

Years Known * (Rounded to the nearest year)

Reference

Name *

Organization/Position *

Telephone *

Email

Relationship *

Years Known * (Rounded to the nearest year)

Certifications

Please indicate any current certifications you hold, including expiration date or the date you will be certified.

First Aid and CPR are required for all program staff before they begin employment. Merrowvista will offer these certification courses in May 2011 at a discounted rate for qualified staff members. Please contact Matt Loper or Joe Baty if you are interested in this course.

If you are not currently certified, please indicate the date in which you plan to take a course.

CPR Date your certification expires or date of a course you have signed up for.

CPR for Professional Rescuer Date your certification expires or date of a course you have signed up for.

First Aid Date your certification expires or date of a course you have signed up for.

Wilderness First Responder Date your certification expires or date of a course you have signed up for.

Wilderness First Aid Date your certification expires or date of a course you have signed up for.

Water Safety Instructor Date your certification expires or date of a course you have signed up for.

Lifeguard Date your certification expires or date of a course you have signed up for.

Wilderness EMT Date your certification expires or date of a course you have signed up for.

Archery Date your certification expires or date of a course you have signed up for.

White Water Canoe Name of White Water Canoe Course

Other-- Please Specify

Skills and Interest Survey

Please tell us a little about your experience and interest in the following areas. You do not need previous experience to lead activities, and all staff will undergo an extensive training period prior to facilitating youth.

If applicable, please give a brief narrative of your experience with leading team building activities and facilitating challenge courses. High and low elements, field initiatives, debriefing, etc.

Please give a brief narrative of your experience with the natural world and/or environmental education. Courses you've taken, classes you've taught, back country experience, particular areas of expertise and interest, etc.

Please list any additional skills, qualifications or interests you possess which would contribute to the programming at Merrowvista.

Personal Insight Questions

Please respond to the following questions.

Why are you interested in the Merrowvista Internship and what do you hope to gain from this experience? You may cut and paste a response or type in this box.

Describe your experience working with children or adolescents. You may cut and paste a response or type in this box.

Please describe your experience living and working in community and/or the skills you possess which allow you to live and work in community effectively.

Employment Eligibility

Do you have the legal right to work in the USA? * YesNo

If you are not a U.S. Citizen, what type of visa do you have?

Have you ever been convicted of a crime ? * YesNo A conviction or court-martial is not necessarily a bar to employment. You may exclude minor traffic violations.

Please explain:

Have you ever been discharged or asked to resign by a previous employer? * YesNo

Please Explain

Personal Commitment

If selected for a leadership position with the American Youth Foundation, I will assume my responsibility conscientiously, give the camp and its directors my support and best effort, and at all times set the proper example for participants. I agree to abide by the American Youth Foundation’s policy prohibiting the use and possession of tobacco, alcohol and other illegal drugs on camp property. In addition, I will not be under the influence of such substances on camp property. Before commencing employment, I will obtain certification in CPR and First Aid, provide consent for verification of a clear criminal history, provide three written references, furnish a current physical examination and health history form, furnish legal documentation of my eligibility to work in the United States, and complete any necessary forms (i.e. tax withholding forms, I-9, etc) required for employment and participation with the AYF.

I have read and agree with these responsibilities. * Yes, I accept these responsibilities.No

Do you consent to a police record search? * Yes, I give my consent.No, I do not consent. State laws require a police record search on all adults working with children under the age of 18. Please indicate consent to such a search.

Please read carefully before submitting your application.

I hereby certify that my answers on this application are true and I understand that any information withheld or falsely provided by me in connection with the foregoing application may be grounds for rejection of my application or will subject me to immediate termination of employment. I understand this application is not an obligation to provide employment. The application will be kept active for 6 months and it must be renewed to be active for a longer period. I also recognize that my employment is based on receipt of satisfactory information from former employers or references. I hereby authorize the American Youth Foundation (AYF) without liability to contact prior employers (present employers, if authorized). I also authorize references given by me and authorize said employers or references to make full response to any inquiries by the AYF concerning this application for employment. Inasmuch as said information concerning my performance and conduct as an employee is furnished at my specific request and for my benefit, I hereby agree to hold harmless the AYF and all former employers and references listed on this application from any liability or claims of whatsoever nature. The employment relationship is by its nature a mutual one and I understand that just as I am free to terminate my employment at any time and at my option, with or without notice, AYF retains a similar right. I further certify that I have read the foregoing information and herewith knowingly make this authorization by setting forth my signature below.

I certify that I have read this information and I knowingly make this authorization by setting forth my signature below. *

THE AMERICAN YOUTH FOUNDATION IS AN EQUAL OPPORTUNITY EMPLOYER

Dedicated to a policy of non-discrimination in employment on any basis including race, color, sex, religion, national origin, age, sexual orientation, disability or veteran’s status, or any other class protected by law. This application remains current for 90 days. Re-application is required thereafter.

Applicants with disabilities may, consistent with the Americans With Disabilities Act, request accommodations needed to participate in the application process. Please contact the site specific office.

The American Youth Foundation's Camp Merrowvista www.ayf.com