Please fill out all relevant information to the best of your ability. Incomplete applications may not be reviewed or accepted. All complete applications will undergo a careful review process, including reference checks. Inquiries can be sent to [email protected]. Personal Information I am applying for the position of Select Position Counselor Junior Counselor Art Kitchen Bus Driver Lifeguard Archery Other First name Middle name Last Name Street City State Zip Current School Current Grade If you are applying as a group, please list the other members of your group here. Where did you hear about SGI? Date of Birth: Month January February March April May June July August September October November December Month Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Year Parents Name Parents Email Parents Phone Are you taking NY State regents? Select Yes No If so, what is the date of your last regent? Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 This Year I have looked through the dates of SGI and I am available throughout. Select Yes No EDUCATION Please list high school and seminary/college/yeshiva education, and references for each Year School Reference Name Phone Email Past Work History Provide a record of all relevant employment (paid and volunteer). Include position of camp staff, names and contact information of supervisor. Dates Camp Name Supervisor/Position Phone Email Character References Give names and contact information of two people (not relatives) who have knowledge of your character, experience, work habits and ability. Name Current Phone Number Role Additional Information What contributions do you think you can make at Silver Gan Israel? What contributions do you think a well-run camp can make to children? Please tell us something about yourself that sets you apart and makes you most fit for the job? What do you foresee yourself enjoying most this summer? What do you enjoy doing to relax? Please share one or two things that you can do to build a trusting relationship with your head staff, and one or two things you can do to remove that trust. Are you solution oriented? Please explain. Please share something your head staff can do to support your success, and one or two things they can do to upset you. To ensure the success of the camp and counselors, we employ a complex feedback system. How would you feel about getting constructive feedback from the head counselors and/or directors? While there are many factors that go into matching staff with campers, what age children do you prefer to work with? (Check ALL that apply) K-1st 2nd-3rd Grade 4th Grade & Up Please list any special qualifications you have that will be current through this coming August (WSI, CPR, Lifeguard…) Would you be interested in becoming a certified lifeguard during training this summer? Please list any special skills or hobbies that you possess which might add to the camp experience (guitar, dance, photography, art….) Is there anything else we should know about you? 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.) Select Yes No Criminal Record Have you ever been convicted of a violent crime, a crime against children or any other crime other than a minor traffic offense? If yes, please describe. (Note: We do not request information about those convictions which have been sealed, or expunged, or statutorily eradicated. A prior conviction is not an automatic bar to employment. The type of conviction and when it occurred will be evaluated by the camp before any decision is made.) Select Yes No Authorization to Invest I authorize investigation of all statements herein, including any checks of criminal records, and release the camp and all others from liability 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 applicant may result in dismissal, regardless of the time of discovery by the camp. Name Phone Email Date Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2025 2024 2023 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 Year Thank you for your interest in being part of the Silver Gan Israel summer experience. We appreciate the time you took to fill out this form. 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