University of Florida

Florida 4-H Summer Camp Staff Online Application

For Summer of 2010. Deadline is December 31, 2009. Questions? E-mail Kim Gumbiner

Personal Information

First Name: Middle Initial: Last Name:
SS#: Date of Birth: Day Year

Contact Information

Home Address

Street Address: City:
State: Zip Code: Phone:

Personal Address at College

Street Address: City:
State: Zip Code: Phone:
E-Mail Address:

4-H Participation

Membership

County

Camp Attendance

Camp & Position Selection

Desired camp location:

Press Ctrl to select more than one:

Position(s) for which you are applying and qualified:

Summer Program Director
Camp Staff

Qualifications

Education

  School City, State, Zip Year Major
High School
College, University
Graduate/Professional
Other/Vocational, etc.

Special Training Qualifications:

Please list all current certifications held (first aid, CPR, Lifeguard, etc.)

Areas of Interest, Skills, Qualifications

Archery Healthy Lifestyles Recreation
Canoeing/Kayaking Nature Crafts Swimming
Environmental Ed Outdoor Skills Team Building
Fishing Other (describe) 

Other Qualifications

List 3 activities that you have taught or led at camp before:
List 3 activities that you feel competent to teach:
List 3 activities that you feel you can assist:
Clubs, extracurricular activities, hobbies or special interests/skills:

Personal Statement

Please write a statement addressing why you would like to serve as a part of Florida 4-H Camp staff. Include positive contributions you feel you can make to camp as well as attributes or characteristics you have that will enable you to be a good staff member.

References

List three references other than immediate family members.

  1. Name, Address (incl. City, State, and Zip), Phone Number
  2. Name, Address (incl. City, State, and Zip), Phone Number
  3. Name, Address (incl. City, State, and Zip), Phone Number

Acknowledgement

By executing this employment application...

  • I authorize the release to Florida 4-H of any document or information within the possession of a third party, such as an educational institution or licensure board, that may serve to verify any representation I have made in this employment application.
  • I also acknowledge that Florida law requires a Florida Department of Law Enforcement Criminal History check and HRS background check for all camp personnel and this background research will be completed prior to employment.

UF/IFAS is an Equal Opportunity/Affirmative Action Employer authorized to provide research, education information and other services only to individuals and institutions that function without regard to race, color, gender, age, handicap or national origin.

UF IFAS Extension