Nurse Application

Firstrequired

MIrequired

Lastrequired

Gender Male Femalerequired

Are you over 21? Yes Norequired

Smoker Yes Norequired

Street

Street

City

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Zip

Country

Phone

e-mail

Business/School Address

Street

Street2

City

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Zip

Country

Phone

Will you require housing for the summer? Yes Norequired

Do you have children interested in attending camp? If so, list them here.

Name

Age

Grade

Name

Age

Grade

Education

College

Name

City

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Country

Major

Dates attended

Did you graduate? Yes No

Grad School

Name

City

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Country

Major

Dates attended

Did you graduate? Yes No

Educational, Camp or Pediatric Experience:

Experience 1 (most recent)

Employer/Organization

Position

Address

Dates

What did you do there?

Experience 2

Employer/Organization

Position

Address

Dates

What did you do there?

Experience 3

Employer/Organization

Position

Address

Dates

What did you do there?

Past Employment

Experience 1

Employer

Location

Phone Number

Dates Employed

Job Responsibilities

Experience 2

Employer

Location

Phone Number

Dates Employed

Job Responsibilities

Experience 3

Employer

Location

Phone Number

Dates Employed

Job Responsibilities

References

Reference 1

Name

Phone

Relationship

Dates Known

Reference 2

Name

Phone

Relationship

Dates Known

Reference 3

Name

Phone

Relationship

Dates Known

Position Request

Became Interested in CCS thoughPlease Select OneFriend (enter name ==>)CCSC WebsitePrevious CCSC ExperienceAmerican Camp AssociationInternetOther (enter name ==>)

Other

Salary Expectedrequired

Why do you want to spend your summer at a camp?

What experience and credentials do you feel you have which will contribute to your role at camp?

Nursing Certification

Certificate of registration as

Registration Number

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Expiration date

Other Certifications

Lifeguard Training

WSI

LG Instructor

US Small Boat Instructor

CPR Instructor

CPR

First Aid Instructor

First Aid

Other

Other Date

Other

Other Date

Criminal Record

Do you understand that we do CORI Checks (Criminal Background) on all employees? Yes Norequired

I authorize Cape Cod Sea Camps to request information from any law-enforcement agency, including police and sheriff departments of this state or federal government, to the extent provided by state and federal, pertaining to any conviction(s) I might have had for violations of state or federal laws, including but not limited to convictions for crimes upon children.

 Yes Norequired

I hereby affirm that the information provided on this application (and any resume submitted) is true and complete. I understand that any false or misleading representations or omissions may disqualify me from further consideration for employment and may result in discharge if discovered at a later date. I understand that completion of this application does not assure me of a position with Cape Cod Sea Camps. I also understand that neither this application nor any other document constitutes a contract of employment for a specific term and that any employment relationship that may be established will be "at will" and may be terminated at any time, with or without cause, by me or Cape Cod Sea Camps. I understand that no representative of the Cape Cod Sea Camps has any authority to enter into any agreeement for employment with me contrary to the foregoing. I hereby authorize Cape Cod Sea Camps to investigate all information pertinent to my application in order to determine my qualifications for employment. I hereby authorize all persons and organizations having information relevant to my application to provide that information to the Cape Cod Sea Camps and I hereby agree to hold harmless Cape Cod Sea Camps and all those providing information to it from any liability arising out of or as a result of the provision of use of such information. I understand that any offer of employment may be rescinded if my references are inadequate or unacceptable to Cape Cod Sea Camps.

 Yes Norequired

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