APPLICATION FOR EMPLOYMENT

PLEASE PRINT IN INK.

NAME: ______PHONE:(______)______

___HOME ADDRESS: ______

___SCHOOL ADDRESS: ______

(PLACE “X” IN FRONT OF ADDRESS MAIL SHOULD BE SENT TO)

E-MAIL ADDRESS: ______SOCIAL SECURITY NO:______

SEX____ DATE OF BIRTH____ MARITAL STATUS____ HT____ WT_____

HAVE YOU BEEN CONVICTED OF A CRIME WITHIN THE LAST SEVEN (7) YEARS?______

IF YES, PLEASE EXPLAIN:______

EDUCATION: (INCLUDE CURRENT YEAR/TO BE COMPLETED AS OF MAY, 2014)

SCHOOL / MAJOR/STUDIES / GRADUATE OR LAST YEAR COMPLETED

PREVIOUS EMPLOYMENT: (LIST MOST RECENT FIRST)

EMPLOYER / PHONE (w/area code) / IMMEDIATE SUPERVISOR / DATE(S) OF EMPLOYMENT

REFERENCES: (AT LEAST TWO (2) PROFESSIONAL – PLEASE DO NOT LIST FAMILY MEMBERS)

NAME / MAILING ADDRESS / PHONE (w/area code)

WHAT CURRENT CERTIFICATIONS DO YOU HOLD? (List expiration dates and if you are YMCA, Lifeguard, First Aid/CPR, Red Cross, Scout, ACA, etc. certified): ______

______

HAVE YOU HAD PREVIOUS EXPERIENCE IN WORKING WITH CHILDREN? ______

IF SO, EXPLAIN: ______

______

HAVE YOU WORKED AT A CAMP OR WITH CHILDREN BEFORE? ______

IF YES, DETAIL: ______

WHY ARE YOU INTERESTED IN WORKING AT A CAMP, MOST ESPECIALLY OURS, THIS SUMMER? ______

ARE YOU AVAILABLE TO WORK MAY 25 – AUGUST 1, INCLUSIVE?______

IF NOT, WHEN ARE YOU AVAILABLE? ______

PLEASE LIST ANY SPECIAL INTERESTS OR HOBBIES YOU MAY HAVE WHICH YOU WOULD FEEL QUALIFIED IN TEACHING OR ASSISTING: ______

______

LIST ANY OTHER SKILLS YOU MAY HAVE THAT WOULD BE HELPFUL TO OUR CAMPING PROGRAM AND/OR CAMPERS: ______

WHAT QUALITIES DO YOU POSSESS WHICH MAKE YOU FEEL YOU WOULD BE A GOOD CAMP COUNSELOR? ______

HAVE YOU WORKED WITH CHILDREN FROM LOW-INCOME HOMES BEFORE? ______

WHAT SPECIAL QUALITIES AND/OR NEEDS DO YOU FEEL THEY MAY HAVE? ______
______

WHAT DO YOU HOPE TO GAIN FROM WORKING AT A CAMP THIS SUMMER? ______

WHAT, AS A COUNSELOR, WOULD YOU LIKE THE CAMPERS TO GET OUT OF THEIR WEEK AT CAMP? ______

I CERTIFY THAT ALL ANSWERS BY ME ARE TRUE, ACCURATE AND COMPLETE, AND I UNDERSTAND THAT FALSIFICATION, OMISSIONS OR MISREPRESENTATIONS OF FACTS CALLED FOR IN THIS APPLICATION OR ANY OTHER ACCOMPANYING OR REQUIRED DOCUMENTATION WILL BE CAUSE FOR DENIAL OF EMPLOYMENT OR IMMEDIATE TERMINATION OF EMPLOYMENT, REGARDLESS OF WHEN OR HOW DISCOVERED.

AS AN EQUAL OPPORTUNITY EMPLOYER, THE KENTUCKY SHERIFFS’ BOYS & GIRLS RANCH ABIDES BY APPLICABLE NON-DISCRIMINATION LAWS AND WILL NOT UNLAWFULLY DISCRIMINATE AGAINST ANY APPLICANT/EMPLOYEE DUE TO RACE, COLOR, AGE, SEX, RELIGION, NATIONAL ORIGIN, ANCESTRY, VETERAN STATUS, DISABILITY AND THE LIKE.

THE KENTUCKY SHERIFFS’ BOYS & GIRLS RANCH IS A DRUG FREE WORKPLACE AND HAS ZERO TOLERANCE FOR ILLICIT DRUGS OR ALCOHOL. IF I AM EMPLOYED, I UNDERSTAND AND AGREE THAT THE KENTUCKY SHERIFFS’ BOYS & GIRLS RANCH MAY REQUEST A TEST FOR DETECTION OF ILLICIT DRUGS/ALCOHOL AND HEREBY CONSENT TO SUCH TEST AND AUTHORIZE THAT IT BE PERFORMED AND THAT EMPLOYER BE INFORMED OF THE RESULTS.

IF HIRED, I AGREE TO ABIDE BY THE RULES AND POLICIES CURRENTLY IN EFFECT OR WHICH MAY BE ESTABLISHED IN THE FUTURE AND TO CONDUCT MYSELF IN ACCORDANCE WITH THEM. I UNDERSTAND EMPLOYMENT IS ON AN “AT WILL” BASIS AND MY EMPLOYMENT MAY BE TERMINATED WITH OR WITHOUT CAUSE, WITH OR WITHOUT NOTICE, AT THE OPTION OF EMPLOYER.

I AUTHORIZE VERIFICATION OF ANY INFORMATION CONTAINED IN THIS APPLICATION AND INVESTIGATION OF ALL STATEMENTS AND INFORMATION CONTAINED IN THIS APPLICATION, INCLUDING BUT NOT LIMITED TO A CRIMINAL BACKGROUND CHECK BEING PERFORMED ON MY BEHALF.

DATED:______SIGNED:______

APPLICANT SIGNATURE

Please note: Incomplete applications cannot be verified and delay the hiring process. Please do not submit incomplete applications! Thank you!