Staff Application - Chabad of S. Barbara
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Please fill out ALL relevant information to the best of your ability.  Incomplete applications may not be reviewed or accepted.  All complete applications will undergo a careful review process, including reference checks.  Inquiries can be sent to

Name:*  Social Security Number:

Permanent Address:
                                Street & Number                            City                      State              Zip
Phone:*   Fax:  

Dates Available: From   To
What type of position do you want?  Salary desired?

Where did you hear about CGI S. Barbara?* 

Note:  We will only review applications that have Phone Numbers for References. 

Past Work History - Provide a record of all relevant employment (paid and volunteer).  Include position of camp staff and names and contact info. of supervisor. 


Camp City and Supervisor Name

Phone & Email

Your Position

Character References - Give names and contact info. of two persons (not relatives) having knowledge of your character, experience, work habits and ability. 




Education - Please list High School and Seminary/College Education, and References' names and contact info. 



Reference Name


Current Grade 
If you are applying as a group, please list the other members of your group here:
 CPR/1st Aid Certification
I am certified in CPR/1st Aid through the end of July of this year.
 I am not CPR/1st Aid certified, and will require training in camp.
 I am not CPR/1st Aid certified, and will arrange for my own training.

Driver's License
I have a valid driver's license.  State:

What contributions do you think you can make at Camp Gan Israel?

What contributions do you think a well-run camp can make to children?

What age children do you prefer working with? (Check ALL that apply) 
 Preschool   1st-3rd Grade   4th Grade & Up 

Harassment - The camp's policy is to prohibit all forms of harassment by our employees.  This includes sexual, racial, religious, and other forms of harassment.  Have you ever been accused of harassment of any person including, but not limited to, workplace harassment? (Note: a prior accusation or conviction is not an automatic bar to employment.  The type of conviction or accusation and when it occurred will be evaluated by the camp before any decision is made.)
Yes    No

Criminal Record - Have you ever been convicted of a violent crime, a crime against children or any other crime other than a minor traffic offense?  If yes, please describe.  (Note:  We do not request information about those convictions which have been sealed, or expunged, or statutorily eradicated. A prior conviction is not an automatic bar to employment.  The type of conviction and when it occurred will be evaluated by the camp before any decision is made.)
 Yes    No

Authorization to Invest
I authorize investigation of all statements herein, including any checks of criminal records, and release the camp and all others from liability in connection with same.  I understand that, if employed, I will be an at-will employee unless there is an agreement or law which alters that status.  Furthermore, I understand that any agreement must be in writing and signed by the designated camp official.  I also understand that untrue, misleading, or omitted information herein or in other documents completed by the applicant may result in dismissal, regardless of the time of discovery by the camp.
Name:*  Date:*