Staff Application

Westcoast Connection Active Teen Tours - 360° Student Travel

Summer Employment Application Form

Personal Information

* Denotes Mandatory

First Name*:

Last Name*:

Email*:

Permanent Cell*:

Permanent Phone*:

Permanent Address:

Permanent City:

Permanent State/Prov:

Permanent Zip/Postal Code:

Temporary Address:

Temporary City:

Temporary State/Prov:

Temporary Zip/Postal Code:

Temporary Phone:

Until what date?

Birth Month:

Birth Day:

Birth Year:

Age as of July 1, 2012*

Social Security(US) or Social Insurance Number(CDN)

Drivers License State/Prov:

License Number:

Summer Camp Work Experience

Camp:

Director:

Phone Number:

Year Worked:

Position:

Please feel free to include additional comments outlining your responsibilities, and the age groups you have worked with.

Camp:

Director:

Phone Number:

Year Worked:

Position:

Please feel free to include additional comments outlining your responsibilities, and the age groups you have worked with.

Camp:

Director:

Phone Number:

Year Worked:

Position:

Please feel free to include additional comments outlining your responsibilities, and the age groups you have worked with.

Education

Please provide information relative to your most recent academic status:

Undergraduate School Attended:

Major:

Year Completed:

Graduate School Attended:

Degree Earned or Year Completed:

Are you currently a teacher/educator:

Yes No

If yes, grade and subject:

Grade:

Subject:

Employment History (Other than Camp)

1.Name of Firm:

Dates employed:

Address:

Position/Responsibilities:

Immediate Supervisor:

Immediate Supervisor Phone:

Reason for leaving:

2.Name of Firm:

Dates employed:

Address:

Position/Responsibilities:

Immediate Supervisor:

Immediate Supervisor Phone::

Reason for leaving:

3.Name of Firm:

Dates employed:

Address:

Position/Responsibilities:

Immediate Supervisor:

Immediate Supervisor Phone::

Reason for leaving:

Placement Preferences

Please indicate to us your preferences for placement for the summer of 2012.

I would like to be considered for the position of:
(you may check more than one):

Trip Director:
(23 years or older)

Food Director:

Trip Leader:

Trip Leader and Lifeguard: Note: all certifications must be valid through August 2012

on the following type of trip (you may check more than one):

Active Teen Tour:

Global Adventure:

Community Service Program (Please note that you must have experience in this area to apply for this program)

Language Program - Spain and/or Costa Rica and/or Peru
(Please note that you must be proficient in Spanish to apply for this program)

Pre-College Enrichment:

Any of the Above:

Expertise

If applicable, please rate your expertise from 1(inexperienced) to 5(highly experienced) and place an ‘x’ if you have ever coached and/or competed and/or studied in any of the following activities:

Please rate your expertise from 1(inexperienced) to 5(highly experienced) and place a check if you have ever coached and or competed in any of the following activities:


	Rating	Coached/Taught	and/or	Competed at:	and/or	Studied:
Camping:				N/A
Skiing (snow):
Snowboarding:
Photography :
Creative Writing:
Fitness :

Languages: Do you speak:
French?	Yes No	Are you fluent?	Yes No
Italian?	Yes No	Are you fluent?	Yes No
Spanish?	Yes No	Are you fluent?	Yes No
Hebrew?	Yes No	Are you fluent?	Yes No

Have you ever lived/worked/studied abroad?:

Yes No

If yes, where? :

Have you ever been a participant of a travel program?:

Yes No

If yes, where did you travel? :

Qualifications

Applicants who are subsequently hired will be required to submit photocopies of various certifications that they hold and that are valid through the end of their specific trip. Please indicate with check marks the courses that you have successfully completed. If you have not completed the necessary courses, you may do so upon being hired.

Swimming:

WSI:

Expiry Date:

Instructor's:

Expiry Date:

National Lifeguard:

Expiry Date:

Note: If you plan on applying for a lifeguard position, all certificates MUST be up to date and valid until August 2012.

First Aid:

Basic First Aid:

Expiry Date:

CPR:

Expiry Date:

Note: ALL staff MUST have first aid and CPR certification valid until August 2012. Wilderness 1st Aid is optional.

Driving:

Driver's License:

15 Passenger Van License:

Note: For Global Adventure, Sports and Community Service Applicants: All applicants to these divisions may require additional licensing to operate the vehicles on our programs. Licensing will be discussed with you if you should be given an interview.

Quebec applicants: must have a full license (not probationary).
Ontario applicants: must have a valid “G” license for at least 2 years

Please Answer the Following Questions

Do you smoke cigarettes?

Yes No

As the trips require physical participation as well as a degree of physical work, do you have any physical limitations that would restrict you from performing your job?

Yes No

If so, please explain:

Have you been found guilty of a criminal offense (this includes abuse and driving offenses and any youth offender conviction, for which you may or may not have received a pardon)?

Yes No

If so, please explain:

Are you available to attend our Pre-Camp Training session tentatively scheduled from Friday, June 1 - Sunday June 3, 2012??

Yes No

Trip Directors only: Are you also available for our Trip Director seminar on the weekend of
Friday, April 27 - Sunday April 29, 2012?

Yes No

How did you hear about Westcoast Connection / 360º Student Travel (please be specific – i.e. name of person, advertisement, etc.)?

SHORT RESPONSES

Please answer all of the following questions in the space provided or on a separate sheet. Please be concise – word maximum is 150 words for each response.

Why do you want to work with Westcoast Connection / 360º Student Travel this upcoming summer?

What would you bring to the Westcoast Connection / 360º Student Travel team?

What would you see as a challenge(s) with the position you have applied for?

Additional Character References
(excluding friends or personal relatives)

Name and Title:

Phone Number:

Address:

Name and Title:

Phone Number:

Address:

Name and Title:

Phone Number:

Address:

I have read and I understand the job description & responsibilities of the position that I am applying for.

I understand that communication will be done via email and I will ensure that @westcoastconnection.com is a ‘safe’ email domain.

All Westcoast Connection / 360º Student Travel employees will be required to submit a recent medical history in the spring of 2012. We thank you for taking the time to fill out this application form. If you do not have a valid reference at this time, please ensure that you bring your reference with you if you should be chosen for an interview.

By submitting below, you are confirming that the information contained within this application is true and accurate. Further, you authorize Westcoast Connection / 360º Student Travel to obtain information about any of the following: my employment history, criminal history, driving records, and/or educational records and release all concerned from any claims arising out of or relating to any such investigation.

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