First Name:
Last Name:
Street Address:
City:
State:
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip Code:
Email:
Primary Phone Number:
Secondary Phone Number:
Gender:
Male
Female
Current Age Status:
17 and under
18 and over
21 and over
Social Security Number:
-
-
Date you are available to start work:
Last date available to work:
August 3, 2012
August 10, 2012
August 17, 2012
August 24, 2012
Tshirt size:
S
M
L
XL
XXL
XXXL
Age group to work with:
Have you ever worked for Oasis Before?
Yes
No
How did you learn about Oasis?
College Career Center
Career Fair
School Advisor
High School Advisor
Internet
Facebook
Posting or Advertisement
Word of Mouth
Worked in Oasis After School Program
Other
Referring Source Name (Name of person, school, website, etc… you learned about Oasis):
After reviewing the job descriptions and qualifications on our website, for which position would you like to be considered?
First Choice:
Group Leader
Group Leader: Teen Travel
Group Leader: Hi-Five
Program Instructor: Art
Program Instructor: Sports/Games
Program Instructor: Swim
Program Instructor: Performing Arts
Program Instructor: Sports
Program Instructor: Outdoor Education
Program Instructor: Other
Office/Admin Staff
Maintenance/Support Staff
Division Leader
Teen Travel Director
Program Director
Operations Director
Health Director
Swim Director
Site Director
Second Choice:
Group Leader
Group Leader: Teen Travel
Group Leader: Hi-Five
Program Instructor: Art
Program Instructor: Sports/Games
Program Instructor: Swim
Program Instructor: Performing Arts
Program Instructor: Sports
Program Instructor: Outdoor Education
Program Instructor: Other
Office/Admin Staff
Maintenance/Support Staff
Division Leader
Teen Travel Director
Program Director
Operations Director
Health Director
Swim Director
Site Director
After reviewing the program locations on our website,
for which location would you like to be considered?
First Choice Location:
Brooklyn
Long Island
Manhattan
Massachusetts
New Jersey
Queens
Westchester
Second Choice Location:
Brooklyn
Long Island
Manhattan
Massachusetts
New Jersey
Queens
Westchester
Education
Are you currently a Student?
Yes
No
Name of Current School or School Last Attended:
High School Name:
High School Grade Completed:
9th
10th
11th
Graduated
GED
College Status in 2012-2013:
Freshman
Sophomore
Junior
Senior
Graduate
Working towards Masters Degree
Graduated with Masters Degree
College Major:
Degree Earned (if any):
PAST EMPLOYMENT
Name of Previous Job 1:
Type of work:
City:
State:
Dates Worked:
Name of Previous Job 2:
Type of work:
City:
State:
Dates Worked:
Name of Previous Job 3:
Type of work:
City:
State:
Dates Worked:
CAMP EXPERIENCE: (Either worked at or attended)
Name of Previous Camp:
State:
Camper or Staff?:
Camper
Staff
Name of Previous Camp 2:
State:
Camper or Staff?:
Camper
Staff
CURRENT CERTIFICATIONS/CREDENTIALS:
Certification information must be entered for Swim Staff and Health Directors. Certification must be valid through September 2012.
CPR:
Expires:
Standard First Aid:
Expires:
Advanced First Aid:
Expires:
EMT:
Expires:
Lifeguard:
Expires:
Water Safety Instructor:
Expires:
LPN/RN:
Expires:
Teaching Certificate:
Expires:
Epi-Pen:
Expires:
OPEN ENDED QUESTIONS:
Why are you applying to work with Oasis?
What strengths do you feel you would bring
to this position? (please use your first choice position when answering)
Have you ever worked with children before? If so, explain in what capacity and if not, explain why you are interested in working with children:
It is the first day of camp and your group is preparing to run an opening event for 15 kids. What would you suggest to get them excited for camp?
REFERENCES: (Please list only professional references: Employer, Advisor, Coach, etc., and provide a valid email address for each. Applications will not be reviewed without valid email addresses for all references.)
Name of Reference 1:
Reference 1 Email Address:
Reference 1 Phone Number:
In what capacity do you know this person?
Coach
Guidance Counselor/Academic Advisor
Employer
Religious Leader
Supervisor
Teacher/Professor
Name of Reference 2:
Reference 2 Email Address:
Reference 2 Phone Number:
In what capacity do you know this person?
Coach
Guidance Counselor/Academic Advisor
Employer
Religious Leader
Supervisor
Teacher/Professor
Name of Reference 3:
Reference 3 Email Address:
Reference 3 Phone Number:
In what capacity do you know this person?
Coach
Guidance Counselor/Academic Advisor
Employer
Religious Leader
Supervisor
Teacher/Professor
Have you ever been convicted of a felony or misdemeanor?
Yes
No
If yes, please indicate the dates and circumstances:
Have you ever been convicted of child abuse or a sexual offense?
Yes
No
Certification and Release (PLEASE CHECK BOX BELOW TO DIGITALLY SIGN THIS DOCUMENT)
· To the best of my knowledge and belief, the information given truly represents my background and experience. I understand that if I have knowingly or negligently misrepresented, falsified or omitted any information during the application process, I may be disqualified for employment consideration or dismissed from employment with Oasis Children's Services.
Date (mm/dd/yyyy):
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