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Summer 2018 New Counselor Application
Please fill out the following fields:
Name *
Legal name (if different from above):
Gender Identity
2018
Preferred pronous
Current address (Street, City, State, Zip)
Please list addresses from at least 5 years back.
Is this your permanent residence?
Unnamed
How long have you lived at current residence?
Email *
Phone number *
Cell Number
Driver's License #
Expiration date
Are you at least 18 years old? (All staff must be AT LEAST 18 years old)
Are you a US or Canadian citizen, or have you been a lawful legal resident in the US for at least 10 years? *
Yes
No
*Note
If you are accepted as a volunteer counselor, may we release the following to other volunteers and medical staff?
How did you hear about the Laurel Foundation
Do you speak any other language(s) other than English?
Have you ever worked with individuals with HIV/AIDS? *
Yes
No
Do you have any hesitations about working with individuals with HIV/AIDS? *
Yes
No
Please indicate you are available to commit to the entire camp session dates below: *
Summer Camp (June 30th - July 7th, 2018)
Rank your preference *
Cabin Counselor
Rank your Cabin Counselor age group preferences from 1 (more interested) to 3 (less interested).
Juniors
Seniors
CITs
Intermediates
Rank your preference *
Activity Counselor
Activity Counselor
Please rank your areas of interest from 1 (most interested) to 8 (least interested).
Arts & Crafts
Cabin Counselor
Outdoor Activities
Dance
Team Building
Drama/Theater
Overnight Adventure Leader
Sports
Music
Experience with youth List any past volunteer/professional experience working w/ youth, starting with the most recent. *Include dates involved, supervisor name and contact info, and your position and duties
Employment History Please provide the following information for your past 3 employers or assignments, starting with most recent. *Include dates worked, employer name, location, phone number, supervisor name, and reason for leaving.
Educational Background *Include school name, number of years attended, and area of study
Professional References (MUST LIST 3)
Name
Relationship
Company Name
Occupation
Email *
Phone *
Name
Relationship
Company Name
Occupation
Email *
Phone *
Name
Relationship
Company Name
Occupation
Email (COPY) *
Phone *
Certification/Skills
Are you currently certified for CPR? *
Yes
No
Are you currently certified for First Aid? *
Yes
No
If yes, please photocopy both sides of all of your certifications and attach to this application.
If no, will you make arrangements to obtain this prior to camp?
Yes
No
If you hold any of the following certifications, please check and attach a copy of certificate to application (THESE ARE NOT REQUIRED TO VOLUNTEER)
Please let us know any special skills you posses! (This will assist when assigning positions)
Dietary Needs *
None
Vegan
Vegetarian
Other
If other, please specify.
All counselors must have a TB test and medical check up within 12 months prior to the camp session. If selected, will you provide The Laurel Foundation with a copy of your TB test and medical check up prior to camp certifying that you will not pose a health risk to campers or other staff (e.g., do not suffer from any contagious diseases)? *
Yes
No
Mandatory Staff Training will be June 9th-June10th (Every counselor MUST attend a full two-day training at least once every 12 months) I’m available to attend the MANDATORY Staff Training: *
Yes
No
Smoking Policy:
Essay Question #1: How would you implement behavior management in the camp setting? *
Essay Question #2: Describe a time when you put the needs of others ahead of your own. What were the circumstances? Why did you do it? *
Essay Question #3: Give us an example of a time when you did not act with integrity. What were the circumstances? Why didn’t you? What happened as a result? *
Essay Question #4: Describe a difficult situation you have encountered involving a conflict with a peer. How did you resolve the issue and what did you learn from the experience? *
Essay Question #5: If selected, what do you think might be your greatest challenge at camp? How would you overcome it? *
Conditions of Employment *By filling out this application, you authorize your typed name as your signature
1. In consideration of the acceptance of my application for participation at the camp session, I hereby waive, release and discharge any and all claims for damages for death, personal injury or property damage which I may have, or which may hereafter accrue to me, as a result of my participation in the camp’s activities and its not for profit parent company, any and all of their agents, representatives and volunteers and employees. This release is intended to discharge in advance the camp, The Laurel Foundation from any and all liability, claims, costs, expenses and/or damages (collectively referred to as “liability”) arising out of or connected in any way with my participation in the activities of The Laurel Foundation, even though that liability may arise of negligence or carelessness on the part of the persons or entities mentioned above. I further understand that serious accidents occasionally occur during camp activities, and that participants in the camp activities occasionally sustain mortal or serious personal injuries and/or property damage as a consequence thereof. Knowing the risks of camp, nevertheless, I hereby agree to assume those risks and to release and hold harmless all of the persons or entities mentioned above who (through negligence or carelessness) might otherwise be liable to me (or to my heirs or assigns) for damages. 2. I understand that during any camping experience involving community and/or environmental living there are inherent health risks, including but not limited to exposure to illnesses, childhood or otherwise, to which I may not have been previously immunized against. Further, I understand that The Laurel Foundation has made every reasonable attempt to minimize these health risks; however, should I experience any illness following any Laurel Foundation program, I should contact my physician or call The Laurel Foundation office (626) 683-0800 to consult with the medical staff. 3. The Laurel Foundation accepts no responsibility for the loss, damage, or theft or volunteers’ property. 4. Volunteer must complete this form to attend camp. *
Statement by Volunteer Applicant:
Have you ever been convicted of a crime (excluding all convictions that have been judicially ordered sealed, expunged, impounded, or statutorily eradicated, misdemeanor convictions for which probation has been completed successfully or otherwise discharged and the case has been judicially dismissed)? If yes, please provide date(s) and details. ANSWERING, “YES” TO THIS QUESTION DOES NOT CONSTITUTE AN AUTOMATIC BAR TO VOLUNTEER SELECTION. FACTORS SUCH AS DATE OF THE OFFENSE, SERIOUSNESS AND NATURE OF THE VIOLATION, REHABILITATION AND POSITION APPLIED FOR WILL BE TAKEN INTO ACCOUNT. *
Yes
No
I certify that all information I have provided in order to apply for a volunteer position with The Laurel Foundation and its not-for- profit parent company is true (herein after referred to as the Laurel Foundation), complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect will allow The Laurel Foundation to (i) cancel further consideration of this application or (ii) immediately relieve me from my volunteer duties, whenever it is discovered. *
I expressly authorize, without reservation, The Laurel Foundation, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions, and to otherwise verify the accuracy of all information provided by me in this volunteer application, résumé or interview. I hereby waive any and all rights and claims I may have regarding The Laurel Foundation, its agents, employees or representatives for seeking, gathering and using such information in the application process and all other persons, corporations or organizations for furnishing such information about me. *
I am advised that the volunteer position that I am applying for involves supervisory or disciplinary power over minors and individuals with disabilities. The Laurel Foundation is authorized under Penal Code section 11105.3 to have access to records of all convictions involving any sex crimes, drug crimes, or crimes of violence of a person who volunteers for a position in which he or she would have supervisory power over a minor. The Laurel Foundation will not select any applicant for a volunteer position involving supervisory or disciplinary power over minors who have been convicted of a crime listed in Penal Code section 11105.3. *
Accordingly, if The Laurel Foundation makes me a tentative offer of a volunteer position, that offer shall be conditioned upon my voluntary submission to fingerprinting and a background criminal conviction records check for other convictions listed above. I have the right to refuse. However, no applicant for positions involving supervisory or disciplinary power over minors shall be accepted for a volunteer position with The Laurel Foundation until the applicant has completed a background criminal records check. *
If I obtain a volunteer position, I understand that I may back out of my volunteer counselor responsibilities up until training. Post training, I may only drop out due to extenuating circumstances. Extenuating circumstances can be defined as, a death in the family, health is-sues, or unforeseen emergencies to be evaluated on a case by case basis. Dropping out of camp, post training, without a sufficient reason will result in a write up, as well as suspension from the next camp. *
Do you currently have any physical or mental conditions, or, are you taking any medication, that would make you unable to perform the duties of the Volunteer Counselor, set forth in the Volunteer Counselor Job Description? If yes, please provide details on a separate sheet of paper. *
Yes
No
If I obtain a volunteer position, I understand that I am free to leave at any time, with or without cause and without prior notice, and The Laurel Foundation reserves the same right to relieve me of my volunteer duties at any time, with or without cause and without prior notice. This application does not constitute an agreement for any specified period or definite duration. I understand that no supervisor or representative of The Laurel Foundation is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by The Laurel Foundation's CEO. I am volunteering my time to The Laurel Foundation to contribute to the community. I have no expectation of compensation or remuneration in any form whatsoever in exchange for my volunteered time. Additionally, The Laurel Foundation has not made any promise of any compensation or remuneration to me for my volunteered time. I am not dependent on The Laurel Foundation economically or otherwise. I have read and fully understand the volunteer counselor or volunteer medical staff job description (whichever applies). I meet all of the minimum qualifications and am able to carry out all of the essential functions detailed therein. I understand that all counselors must be available for two days of training in the city prior to camp to be eligible for any session. *
Upload any documents here!
I understand that no question on this application is used for the purpose of limiting or excusing any applicant from consideration for a volunteer position on a basis prohibited by applicable local, state or federal law. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT. I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
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8
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Confirmation
Experience with youth List any past volunteer/professional experience working w/ youth, starting with the most recent. *Include dates involved, supervisor name and contact info, and your position and duties
Name
Unnamed
Phone number
Cell Number
Educational Background *Include school name, number of years attended, and area of study
How long have you lived at current residence?
Current address (Street, City, State, Zip)
Legal name (if different from above):
Gender Identity
Employment History Please provide the following information for your past 3 employers or assignments, starting with most recent. *Include dates worked, employer name, location, phone number, supervisor name, and reason for leaving.
Please list addresses from at least 5 years back.
Preferred pronous
Is this your permanent residence?
Email
Driver's License #
Expiration date
Are you at least 18 years old? (All staff must be AT LEAST 18 years old)
*Note
Are you a US or Canadian citizen, or have you been a lawful legal resident in the US for at least 10 years?
Have you ever worked with individuals with HIV/AIDS?
How did you hear about the Laurel Foundation
If you are accepted as a volunteer counselor, may we release the following to other volunteers and medical staff?
Do you speak any other language(s) other than English?
Do you have any hesitations about working with individuals with HIV/AIDS?
Please indicate you are available to commit to the entire camp session dates below:
Seniors
CITs
Rank your preference
Rank your preference
Intermediates
Juniors
Arts & Crafts
Outdoor Activities
Dance
Team Building
Drama/Theater
Overnight Adventure Leader
Sports
Music
Rank your Cabin Counselor age group preferences from 1 (more interested) to 3 (less interested).
Please rank your areas of interest from 1 (most interested) to 8 (least interested).
Cabin Counselor
Activity Counselor
2018
Professional References (MUST LIST 3)
Name
Relationship
Company Name
Occupation
Email
Phone
Name
Relationship
Company Name
Occupation
Email
Phone
Name
Relationship
Company Name
Occupation
Email (COPY)
Phone
Certification/Skills
Are you currently certified for CPR?
Are you currently certified for First Aid?
If yes, please photocopy both sides of all of your certifications and attach to this application.
If no, will you make arrangements to obtain this prior to camp?
If you hold any of the following certifications, please check and attach a copy of certificate to application (THESE ARE NOT REQUIRED TO VOLUNTEER)
Please let us know any special skills you posses! (This will assist when assigning positions)
Dietary Needs
If other, please specify.
All counselors must have a TB test and medical check up within 12 months prior to the camp session. If selected, will you provide The Laurel Foundation with a copy of your TB test and medical check up prior to camp certifying that you will not pose a health risk to campers or other staff (e.g., do not suffer from any contagious diseases)?
Mandatory Staff Training will be June 9th-June10th (Every counselor MUST attend a full two-day training at least once every 12 months) I’m available to attend the MANDATORY Staff Training:
Smoking Policy:
Essay Question #1: How would you implement behavior management in the camp setting?
Essay Question #2: Describe a time when you put the needs of others ahead of your own. What were the circumstances? Why did you do it?
Essay Question #3: Give us an example of a time when you did not act with integrity. What were the circumstances? Why didn’t you? What happened as a result?
Essay Question #4: Describe a difficult situation you have encountered involving a conflict with a peer. How did you resolve the issue and what did you learn from the experience?
Essay Question #5: If selected, what do you think might be your greatest challenge at camp? How would you overcome it?
Conditions of Employment *By filling out this application, you authorize your typed name as your signature
1. In consideration of the acceptance of my application for participation at the camp session, I hereby waive, release and discharge any and all claims for damages for death, personal injury or property damage which I may have, or which may hereafter accrue to me, as a result of my participation in the camp’s activities and its not for profit parent company, any and all of their agents, representatives and volunteers and employees. This release is intended to discharge in advance the camp, The Laurel Foundation from any and all liability, claims, costs, expenses and/or damages (collectively referred to as “liability”) arising out of or connected in any way with my participation in the activities of The Laurel Foundation, even though that liability may arise of negligence or carelessness on the part of the persons or entities mentioned above. I further understand that serious accidents occasionally occur during camp activities, and that participants in the camp activities occasionally sustain mortal or serious personal injuries and/or property damage as a consequence thereof. Knowing the risks of camp, nevertheless, I hereby agree to assume those risks and to release and hold harmless all of the persons or entities mentioned above who (through negligence or carelessness) might otherwise be liable to me (or to my heirs or assigns) for damages. 2. I understand that during any camping experience involving community and/or environmental living there are inherent health risks, including but not limited to exposure to illnesses, childhood or otherwise, to which I may not have been previously immunized against. Further, I understand that The Laurel Foundation has made every reasonable attempt to minimize these health risks; however, should I experience any illness following any Laurel Foundation program, I should contact my physician or call The Laurel Foundation office (626) 683-0800 to consult with the medical staff. 3. The Laurel Foundation accepts no responsibility for the loss, damage, or theft or volunteers’ property. 4. Volunteer must complete this form to attend camp.
Statement by Volunteer Applicant:
I certify that all information I have provided in order to apply for a volunteer position with The Laurel Foundation and its not-for- profit parent company is true (herein after referred to as the Laurel Foundation), complete and correct. I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect will allow The Laurel Foundation to (i) cancel further consideration of this application or (ii) immediately relieve me from my volunteer duties, whenever it is discovered.
I am advised that the volunteer position that I am applying for involves supervisory or disciplinary power over minors and individuals with disabilities. The Laurel Foundation is authorized under Penal Code section 11105.3 to have access to records of all convictions involving any sex crimes, drug crimes, or crimes of violence of a person who volunteers for a position in which he or she would have supervisory power over a minor. The Laurel Foundation will not select any applicant for a volunteer position involving supervisory or disciplinary power over minors who have been convicted of a crime listed in Penal Code section 11105.3.
Have you ever been convicted of a crime (excluding all convictions that have been judicially ordered sealed, expunged, impounded, or statutorily eradicated, misdemeanor convictions for which probation has been completed successfully or otherwise discharged and the case has been judicially dismissed)? If yes, please provide date(s) and details. ANSWERING, “YES” TO THIS QUESTION DOES NOT CONSTITUTE AN AUTOMATIC BAR TO VOLUNTEER SELECTION. FACTORS SUCH AS DATE OF THE OFFENSE, SERIOUSNESS AND NATURE OF THE VIOLATION, REHABILITATION AND POSITION APPLIED FOR WILL BE TAKEN INTO ACCOUNT.
If I obtain a volunteer position, I understand that I am free to leave at any time, with or without cause and without prior notice, and The Laurel Foundation reserves the same right to relieve me of my volunteer duties at any time, with or without cause and without prior notice. This application does not constitute an agreement for any specified period or definite duration. I understand that no supervisor or representative of The Laurel Foundation is authorized to make any assurances to the contrary and that no implied, oral or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by The Laurel Foundation's CEO. I am volunteering my time to The Laurel Foundation to contribute to the community. I have no expectation of compensation or remuneration in any form whatsoever in exchange for my volunteered time. Additionally, The Laurel Foundation has not made any promise of any compensation or remuneration to me for my volunteered time. I am not dependent on The Laurel Foundation economically or otherwise. I have read and fully understand the volunteer counselor or volunteer medical staff job description (whichever applies). I meet all of the minimum qualifications and am able to carry out all of the essential functions detailed therein. I understand that all counselors must be available for two days of training in the city prior to camp to be eligible for any session.
I expressly authorize, without reservation, The Laurel Foundation, its representatives, employees or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities and educational institutions, and to otherwise verify the accuracy of all information provided by me in this volunteer application, résumé or interview. I hereby waive any and all rights and claims I may have regarding The Laurel Foundation, its agents, employees or representatives for seeking, gathering and using such information in the application process and all other persons, corporations or organizations for furnishing such information about me.
Accordingly, if The Laurel Foundation makes me a tentative offer of a volunteer position, that offer shall be conditioned upon my voluntary submission to fingerprinting and a background criminal conviction records check for other convictions listed above. I have the right to refuse. However, no applicant for positions involving supervisory or disciplinary power over minors shall be accepted for a volunteer position with The Laurel Foundation until the applicant has completed a background criminal records check.
Do you currently have any physical or mental conditions, or, are you taking any medication, that would make you unable to perform the duties of the Volunteer Counselor, set forth in the Volunteer Counselor Job Description? If yes, please provide details on a separate sheet of paper.
If I obtain a volunteer position, I understand that I may back out of my volunteer counselor responsibilities up until training. Post training, I may only drop out due to extenuating circumstances. Extenuating circumstances can be defined as, a death in the family, health is-sues, or unforeseen emergencies to be evaluated on a case by case basis. Dropping out of camp, post training, without a sufficient reason will result in a write up, as well as suspension from the next camp.
I understand that no question on this application is used for the purpose of limiting or excusing any applicant from consideration for a volunteer position on a basis prohibited by applicable local, state or federal law. DO NOT SIGN UNTIL YOU HAVE READ THE ABOVE APPLICANT STATEMENT. I certify that I have read, fully understand and accept all terms of the foregoing Applicant Statement.
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