Name of Applicant

Birthdate      I will be 18 years of age by December 31, 2008 

E-mail address      Cell # 
Social Insurance Number      Health Card Number 

School Attending 

How did you hear about Camp Shalom? 

What is your availability for this summer?
Full Summer     July session only     August session only

What age group would you prefer to work with? (check all that apply)
7-9     10-11     12-13

CAMP BACKGROUND
Please list your summer camp history

SKILLS & ACTIVITIES

Mark ‘1’ in front of activities in which you have experience and could lead at camp
Mark ‘2’ in front of activities in which you could assist at camp

From the list above, please rank your top three choices

QUALIFICATIONS AND CERTIFICATIONS

List any other awards or certifications (e.g.: OSA, OWSA, ORCKA, ropes, gym):

PERSONAL EXPERIENCES

Please detail your experience working with children.

Do you have any specific experience working with children with special needs?
If so, please elaborate.



Use the space below to describe any special qualifications, such as leadership training, Jewish, 
Zionist, or other youth activities, part time employment, etc. that would be relevant to this application.

CONSENT SECTION:
In accordance with privacy legislation we require your authorization to collect, store and review your personal information and employment history for the purpose of determining your qualifications and eligibility for employment. We also require your consent to review the employment reference information you provide, to contact your references if clarification is required and to conduct additional employment and/or personal references if necessary. Consent must be received before we begin our assessment of your qualifications and eligibility for employment. Please ensure you complete the Consent Section by clicking on the checkbox below.

Camp Shalom respects your right to privacy of personal information and abides by all legislation with respect to privacy. Camp Shalom does not share or use your personal information, other than for the purpose of assessing your qualifications and eligibility for employment. All information provided in your application will be treated as strictly confidential. Access to this information is restricted to only those individuals who will be processing your application and those individuals who will be assessing your qualifications and eligibility for employment.

I authorize Camp Shalom to collect and confidentially store the information I have provided in this application strictly for the use of determining my qualifications and eligibility for employment.

I authorize Camp Shalom to produce a hard copy of my on-line application and to use the information I have provided strictly for the purpose of assessing my qualifications and eligibility for employment.

I authorize Camp Shalom to review the reference information I provide, to clarify the reference information if required and to conduct additional employment and/or personal references if required, strictly for the purpose of determining my qualifications and eligibility for employment.

If I am not hired by Camp Shalom, I understand that Camp Shalom will retain and confidentially store my information for future reference, strictly for the purpose of assessing my qualifications and eligibility for employment. This information will only be disposed at my written request.

According to the OCA Code of Ethics, if you have made a verbal and/or written commitment to another camp or organization, we cannot consider your application.

  I have read the CONSENT SECTION and I agree to all the terms & conditions stated above.