Apply for a summer job at Camp Taconic, in the Berkshires

Name		Soc. Sec. #
Nickname
Position		Salary

Home Address

School or
Dorm Address

Home Phone		School Phone		Date of Birth		Sex: M F
Height		Weight		Marital Status

Children (age & sex)
Email Address
Personal Web Page Address
How did you learn about Camp Taconic?
Please list the camps that you attended as a child and your age when you attended them:

	Name of School	Major	Degree	Date	Dates Attended
Masters
Bachelor's
Associate's
High School

Please list your work experience - Including any camp staff experience:

Name of Camp or Firm	Dates	Position	Salary

Please double-check the activities you can teach, and check those that you can assist:
Aerobics	Cooking	Lacrosse	Silk Screen Printing
Archery	Costume Making	Modern Dance	Silver Jewelry
Art	Crafts	Mountain Biking	Soccer
Ballet	Dramatics	Newspaper	Softball
Baseball	Exercise Equipment	Photography	Stagecraft
Basketball	Field Hockey	Piano Accompaniment	Swimming
Boating	Fishing	Radio Station	Tennis
CampingHiking	Flag Football	Rocketry	Video
Canoeing	Folk Dancing	Roller Blading	Volleyball
Climbing Wall	Golf	Roller Hockey	Waterskiing
Ceramics	Guitar	Ropes Course	Weight Training
Choral Singing	Gymnastics	Sailing	Windsurfing
Computers	Instrumental Music	Science & Nature	Woodworking
			Yoga

Have you ever been certified for:		Lifeguarding - Expiration Date
		Water Safety Instruction
What musical instruments do you play?
Please indicate your interest by checking one or both:
		General Counselor for 7-10 yr. old campers, helping in many activities
		Activity Instructor in one activity and bunk counselor for (check your preference) : 11-12 13 - 14 15-16
Please describe any medical or physical conditions that would limit your participation in our camp program:
Please list all medications you are currently taking and the reasons why:
Do you smoke? Yes No		Are you a vegetarian? Yes No
Do you have any other special or unusual dietary needs?
Do you have any criminal convictions or pending indictments for drug abuse, child abuse, sex related crimes, or any other matters?

Please list three references with a full address and phone number, not related to you, that have supervised your work or education:
Name:
Position:
Address:
Phone:

Describe your qualifications for each of the positions that you would like to have at camp. (If you are only interested in being a general counselor you need not complete the Second and Third Choice sections:
First Choice/ General Counselor:
Second Choice:
Third Choice:
Why do you want to be a counselor?
Please give a brief biography of yourself. Include any interests and experiences not mentioned before that you think may be relevant.