Use this form to apply for a position with our company. Please enter all information requested. Contact InformationEmail* Name* First Last Home Phone*Cell Phone*Work Phone*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Personal InformationDate of Birth* Date Format: MM slash DD slash YYYY Position Applying For*After School InstructorCamp DirectorCamp CounselorScience Curriculum WriterWhy do you feel you would be a good fit for the position you are applying for?*Education InformationEducation Status*Graduate DegreeUndergraduate DegreeHigh School SeniorCollege Attended*Undergrad Major*Year you graduated college:*Graduate School Attended*Credentialed Teacher?*YesNoDo you have CPR Certification?*YesNoFirst Aid Certificate?*YesNoWork and Camp HistoryPlease give a brief description of your work experience relevant to the position you are applying. You may paste work history from your resume.*Please list your experience working with children in church, classroom or summer camp.*Describe an experience in which you were either part of or led a successful team. Describe the situation,the actions you took and the results. (max 200 words)*Describe an unforgettable teaching experience you have had with a child. (Max 200 words)*If you were a teacher or director of summer camp, what would your philosophy be? (Max 200 words)*References/General InformationList 2 professional references, at least one of which is a recent supervisor in a position relevant to this position:*NameRelationship to YouEmail AddressTelephone Number Who do you know who might be interested in learning more about Club SciKidz employment opportunities?*Have you applied for a position with our company before?*YesNoHow did you hear about this employment opportunity?*If you were referred by someone, list them here:*Have you ever been convicted of a felony or misdemeanor?*YesNoHave you ever been involved in an incident involving sexual or physical abuse of a child?*YesNoMiscellaneous InformationDo you have any thoughts/comments about your preferred location? Please go to our website for after school or summer camp location preferences.*Do you have any physical conditions or diseases that would affect your abilities to perform all camp and classroom duties?*YesNoIf yes, please explain:*What is your availability during the summer?*Certification and ReleaseTo the best of my knowledge and belief, the information given truly represents my background and experience. I understand that if I have knowingly or negligently misrepresented, falsified or omitted any information during the application process, I may be disqualified for employment consideration or dismissed from employment with Club SciKidz.* I agree to allow Club SciKidz to do a background check. CommentsQuestion or CommentsEmailThis field is for validation purposes and should be left unchanged.