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Cathedral Domain

Episcopal Camp & Retreat Center

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Camp Staff Application

First Name

Last Name

Today's Date

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Phone

Cell Phone

Email

School Street Address

Street Address Line 2

T-Shirt Size

City

First Date Available to Work

Region/State/Province

Last Day Available to Work

Postal / Zip code

Position Desired

Are you able to perform the essential functions of the job, with or without reasonable accomodations?

YES

NO

Employment History

Starting Date

Ending Date

Employer/Business Name

Supervisor's Name

Employer's Email

Employer's Phone Number

Reason for Leaving

May we contact this employer?

Yes

No

Starting Date

Ending Date

Employer/Business Name

Supervisor's Name

Employer's Email

Employer's Phone Number

Reason for Leaving

May we contact this employer?

Yes

No

Starting Date

Ending Date

Employer/Business Name

Supervisor's Name

Employer's Email

Employer's Phone Number

Reason for Leaving

May we contact this employer?

Yes

No

Starting Date

Ending Date

Employer/Business Name

Supervisor's Name

Employer's Email

Employer's Phone Number

Reason for Leaving

May we contact this employer?

Yes

No

Starting Date

Ending Date

Employer/Business Name

Supervisor's Name

Employer's Email

Employer's Phone Number

Reason for Leaving

May we contact this employer?

Yes

No

Please list all references below who will have knowledge of your character, experience,
work habits, and abilities.

Reference #1 Name

Reference #1 Phone Number

Reference #1 Email

Reference #2 Name

Reference #2 Phone Number

Reference #2 Email

Reference #3 Name

Reference #3 Phone Number

Reference #3 Email

Reference #4 Name

Reference #4 Phone Number

Reference #4 Email

Camp Experience

Select a date

to

Select a date

Camp Name

Director

Location - City, State, & ZIP

Were you a camper ot staff?

Camper

Staff

Select a date

Camp Name

Director

Location - City, State, & ZIP

Were you a camper ot staff?

Camper

Staff

Select a date

Camp Name

Director

Location - City, State, & ZIP

Were you a camper ot staff?

Camper

Staff

Education (High School and/or Beyond)

Select a date

School or Institution

Major/Subjects Studied

Did you Graduate?

Yes

No

If YES, what degree(s) did you receive?

Select a date

School or Institution

Major/Subjects Studied

Did you Graduate?

Yes

No

If YES, what degree(s) did you receive?

Camp Skills & Certification
In the following list, place the corresponding number by the area that applies
1 - Areas where you have a certification
2 - Areas where you can teach or lead
3 - Areas where you can assist

Climbing/Rappelling

Caving

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﻿Cathedral Domain

Camp Staff Application

Employment History

Please list all references below who will have knowledge of your character, experience, work habits, and abilities.

Camp Experience

to

Education (High School and/or Beyond)

Camp Skills & Certification In the following list, place the corresponding number by the area that applies 1 - Areas where you have a certification 2 - Areas where you can teach or lead 3 - Areas where you can assist

Cathedral Domain

Please list all references below who will have knowledge of your character, experience,
work habits, and abilities.

Camp Skills & Certification
In the following list, place the corresponding number by the area that applies
1 - Areas where you have a certification
2 - Areas where you can teach or lead
3 - Areas where you can assist