Online Staff Application

• First Name:
• Last Name:
• Gender: Male Female
• Age (optional):

• Home Address:
• City:
• State:
• Zip:
• Home Phone:
• Cell Phone:
• Email Address:

• College Address:
• City:
• State:
• Zip:
• College Phone:
• Year in school:
• Major:

Can you perform the essential functions of the job with little or no accommodation?
Yes No

• Do you have any health restrictions or allergies that will impede your ability to perform the job applied for? If so, please describe them:
  

• Years attended:
• School name:
• Major:
• Degree:
•  
• Years attended:
• School name:
• Major:
• Degree:

• Dates (from):
• Dates (to):
• Employer:
• Phone:
• Position:
• Supervisor:
• Reason for leaving:
•  
• Dates (from):
• Dates (to):
• Employer:
• Phone:
• Position:
• Supervisor:
• Reason for leaving:

• Name:
• Address:
• City:
• State:
• Zip:
•  
• Name:
• Address:
• City:
• State:
• Zip:
•  
• Name:
• Address:
• City:
• State:
• Zip:

Have you ever worked with children? Yes No

• When:
• Where:
• In what capacity:

Have you ever been a Decoma camper or staff member? Camper Staff Member

Have you ever taught recreational activities? Yes No

• When:
• Where:
• In what capacity:

(rank your experience level: 1=little or no experience; 2=familiar with; 3=excel at)

• Archery: 1 (little or no experience) 2 (familiar with) 3 (excel at)
• Arts & Crafts: 1 (little or no experience) 2 (familiar with) 3 (excel at)
• Basketball: 1 (little or no experience) 2 (familiar with) 3 (excel at)
• Cheerleading/Poms: 1 (little or no experience) 2 (familiar with) 3 (excel at)
• Dance: 1 (little or no experience) 2 (familiar with) 3 (excel at)
• Drama: 1 (little or no experience) 2 (familiar with) 3 (excel at)
• Fencing: 1 (little or no experience) 2 (familiar with) 3 (excel at)
• Fishing: 1 (little or no experience) 2 (familiar with) 3 (excel at)
• Golf: 1 (little or no experience) 2 (familiar with) 3 (excel at)
• Gymnastics: 1 (little or no experience) 2 (familiar with) 3 (excel at)
• Horseback Riding: 1 (little or no experience) 2 (familiar with) 3 (excel at)
• Music/Singing: 1 (little or no experience) 2 (familiar with) 3 (excel at)
• Soccer: 1 (little or no experience) 2 (familiar with) 3 (excel at)
• Swimming: 1 (little or no experience) 2 (familiar with) 3 (excel at)
• Tennis: 1 (little or no experience) 2 (familiar with) 3 (excel at)

Do you have current Certification in Lifeguarding and/or WSI through Red Cross, YMCA or Ellis?
Yes No

Have you ever taught swimming? Yes No

Special achievements or activity in swimming (swim clubs or teams, WSI, intramural, etc.)
Yes No

• When:
• Where:
• In what capacity:

Are you currently certified in CPR? Yes No

Is your First Aid current? Yes No

Do you have transportation to use on a daily basis? Yes No

Do you have a current ILLINOIS Driver’s License? Yes No

Are you at least 21 years old? Yes No

Has your license ever been suspended or revoked? Yes No

Have you had any moving violations in the past two years? Yes No

Are you willing to meet a camp bus wherever we need you to? Yes No

Are you available the entire summer camp season, June 14 to August 6 (Monday through Friday)?
Yes No

If you do not live in the Chicago area, do you have alternate housing available? (i.e. friend, relative)
Yes No

Are you available for an interview? Yes No

• When:

Have you ever been convicted of any crime relating in any manner to children and/or your conduct with them? Yes No