2012 CAMP EMPLOYMENT APPLICATIONName______________________________________________________________________ Social Security No._____________________________

Present Address ____________________________________________________________________________________Until when?____________

Present Phone _____________________________Business Phone____________________________Cell Phone____________________________

Permanent Address _______________________________________________________________________________________________________

Permanent Phone ____________________________________________________ E-mail _____________________________________________

Date of Birth:_________________________Age:________Gender: o M o F

Are you a U.S. citizen? o Yes o No If no, what type of VISA do you have?___________________________________________________________

Have you ever worked for Woodward? o Yes o No If yes, dates and position: _________________________ Were you ever a camper? o Yes o No

Street Address/PO Box/Apt # City State Zip

Street Address/PO Box/Apt # City State Zip

School Most Recently AttendedName__________________________________________ City/State _______________________________ If college, major?___________________Graduated? o Yes o No Now enrolled? o Yes o No If enrolled, what year are you currently in at school? (optional) Fresho Sopho JRo SRo

Three Most Recent JobsCompany_____________________________ Address__________________________________ City_____________________ State____ Zip______Phone______________________ Position___________________ Describe main duties_________________________________________________Supervisor_____________________________________________ Dates worked: From________________________ to _______________________Salary_______________________ Reason for leaving_____________________________________________________________ o Do not contact

Company_____________________________ Address__________________________________ City_____________________ State____ Zip______Phone______________________ Position___________________ Describe main duties_________________________________________________Supervisor_____________________________________________ Dates worked: From________________________ to _______________________Salary_______________________ Reason for leaving_____________________________________________________________ o Do not contact

Company_____________________________ Address__________________________________ City_____________________ State____ Zip______Phone______________________ Position___________________ Describe main duties_________________________________________________Supervisor_____________________________________________ Dates worked: From________________________ to _______________________Salary_______________________ Reason for leaving_____________________________________________________________ o Do not contact

References (one personal, two professional references)

Name __________________________________ Name _________________________________________ Name _______________________________________Address ________________________________ Address _______________________________________ Address _____________________________________________________________________________ ______________________________________________ _____________________________________________Phone __________________________________ Phone ________________________________________ Phone _______________________________________E-mail __________________________________ E-mail ________________________________________ E-mail _______________________________________Relationship _____________________________ Relationship ___________________________________ Relationship __________________________________

ATTACHPHOTOHERE

This is voluntary buthelpful to us in

remembering ourhundreds of previous

staff members!

TODAY’S DATE: ___________________

Woodward CampP.O. Box 93, 134 Sports Camp Drive

Woodward, PA 16882ph 814.349.5633 fx 814.349.5643web www.woodwardcamp.com

email office@campwoodward.com

Last Name First Name

Sports, activities, and other skillsPlease list all professional, technical, recreational, social, etc., skills (teaching, coaching, digital media, crafting, mechanical, hobby, language, clerical,writing, etc.). Where appropriate, include when you participated in the activity, by whom you were coached, what honors you’ve earned, etc.:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Gymnastics, Cheer and Tumbling applicants only: Skills you can spot on floor: _________________________________________________________Are you currently a competitive gymnast, tumbler or cheerleader? Yes o No o If yes where_____________________________________________o Water Safety Instructor certification o Lifeguard certification Did you receive a high school varsity letter in gymnastics? Yes o No o

PAGE 2

Organizations and ActivitiesPlease list all clubs, organizations, groups, etc., to which you have belonged in the past 5 years and/or in which you currently participate:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

HarassmentWoodward’s policy is to prohibit all forms of harassment by our employees. This includes sexual, racial, religious, and/or 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 convictionis 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 ismade.) o Yes oNoExplain: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Criminal RecordHave you ever been convicted of a crime other than a minor traffic offense? If yes, please describe. (Note: A prior conviction is not an automatic bar toemployment. The type of conviction and when it occurred will be evaluated by the camp before any decision is made.) o Yes oNoExplain: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Voluntary Disclosure The following information is voluntary and may affect your employment.

Have you ever been convicted of a crime relating in any manner to children and/or your conduct with them? o Yes oNo

Have you ever been convicted of any crime listed here or similar in any manner to those listed here: indecent assault and battery on a child under 18;rape in any manner; assault with intent to commit rape; kidnapping of a child with or without intent to commit rape; distribution or trafficking of narcoticsor other controlled substance; intent to commit any of these crimes? o Yes oNo

Have you ever been held liable for civil penalties or damages involving sexual or physical abuse of children? o Yes oNo

Are you now or have you ever been subject to any court order involving sexual or physical abuse of a minor, including but not limited to a domesticorder or protection? o Yes oNo

Have your parental rights ever been terminated for reasons involving sexual or physical abuse of children? o Yes oNoPlease provide an explanation to any answers checked “yes”.

I understand that:a. Woodward may deny employment to any person who answers these questions in the affirmative.b. In applying for camp position, the information which I have furnished in this section is subject to verification, which may include a criminal history check and

request from any Central Registry of child abusers.c. Woodward may terminate employment or volunteer service of any person

- Found to have a history of complaints of abuse of a minor and/or- Found to have resigned, been terminated, or been asked to resign from a position whether paid or unpaid due to complaint(s) of sexual abuse of a

minor.d. This disclosure statement must be updated yearly.

Signature: _____________________

Camp Parents__Camp Mom__ Camp Dad__ Driver__ Canteen Parent *

__ Camp Nurse o RN or o LPN

If we have enough Camp Moms and Dads, would you be willing to be a Driver instead o Yes o No or CanteenParent? o Yes o No. Camp Moms and Dads will only be housed with same-sex children; we therefore requestthat you volunteer your gender: o Male o Female. Driving records must be free from traffic violations for thepast two years. Must have a valid US Driver’s License.Driver’s License # ___________________________________________ State______________

Is your child a registered camper? o Yes o NoIf yes, your child’s full name________________________________________________Gymnastics club/cheer team affiliation? ________________________________________________

Actual work dates are Saturday 1:00 P.M.Proceeding the session through Sunday12:00 NOON of the following session. NoExceptions!

Instructional Staff (Must be at least 18 years old)__Gymnastics Instructor/Counselor*1

__Cheer Instructor/Counselor*2

__Tumbling Instructor/Counselor*3

__ Inline Instructor/Counselor*4

__ Skateboard Instructor/Counselor*5

__ BMX Freestyle Instructor/Counselor*6

__ Digital Photography Instructor/Counselor*7

__ Video Production Instructor/Counselor*7

__ Graphics Arts Instructor/Counselor*7

__ Music Studio Instructor/Counselor*7

__ Snowboard/Freeski Instructor/Counselor*8

__ Rockwall Instructor__ Ropes Course Instructor__ Go-Kart Racing Staff__ Camp DJ__ Arts & Crafts Instructor__ Digital Lab Instructor__ Recreational Director—Action Sports__ Recreational Director—Gymnastics__ Athletic Trainer (Certified or currently training)__ Pool Lifeguard__ Paintball__ Skate/Bike Shop__ Other (describe) ___________________

Operational Staff (Must be at least 16 years old)Local staff only; cannot live on camp property. Hourly wages.

__ Camp Store/Canteen Staff *__ Horseback Riding Staff__ Office Staff__ Housekeeping Staff__ Maintenance Staff__ Kitchen Staff *__ Grill Staff *

* The Secretary of Health and Human Services has determined that certain diseases, including hepatitis A,salmonella, shigella, staphylococcus, streptococcus, giardia, E.coli, and compylobacter may prevent you from servingor handling food equipment in a sanitary or healthy fashion. An essential function of this job involves handling andserving food, food service equipment and utensils in a sanitary and healthy fashion. Is there any reason why youcannot perform the essential functions of these jobs? o Yes o No If yes, explain: ____________________________________________________________________________________________________________

C I R C L E D A T E S A V A I L A B L E#1 June 3 – June 9 #7 July 15 – July 21#2 June 10 – June 16 #8 July 22 – July 28#3 June 17 – June 23 #9 July 29 – Aug 4#4 June 24 – June 30 #10 Aug 5 – Aug 11#5 July 1 – July 7 #11 Aug 12 – Aug 18#6 July 8 – July 14 #12 Aug 19 – Aug 25

FULL WEEKS ONLYYOU MUST ARRIVE BY 1: 00 P.M. THE SATURDAY PRECEDING

THE SESSION

Position for which You are ApplyingPlease indicate position(s) for which you are applying. You will be scheduled for complete weeks only (no partial weeks). Actual work days are Sundaythrough Sunday, however arrival is always the Saturday preceding the session you are scheduled to begin work. Job Descriptions are available online atwww.campwoodward.com. Please mark a 1st and a 2nd choice. Salary Required? ____________________

PAGE 3

C I R C L E D A T E S A V A I L A B L E

#1 June 3 – June 9 #7 July 15 – July 21#2 June 10 – June 16 #8 July 22 – July 28#3 June 17 – June 23 #9 July 29 – Aug 4#4 June 24 – June 30 #10 Aug 5 – Aug 11#5 July 1 – July 7 #11 Aug 12 – Aug 18#6 July 8 – July 14 #12 Aug 19 – Aug 25

FULL WEEKS ONLY

C I R C L E D A T E S A V A I L A B L E#1 June 3 – June 9 #5 July 1 – July 7 #9 July 29 – Aug 4#2 June 10 – June 16 #6 July 8 – July 14 #10 Aug 5 – Aug 11#3 June 17 – June 23 #7 July 15 – July 21 #11 Aug 12 – Aug 18#4 June 24 – June 30 #8 July 22 – July 28 #12 Aug 19 – Aug 25

Counselors work Saturday at 1:00P.M. through Sunday 12:00 NOON.No Exceptions!

*1 Gymnastics Weeks: 1-12*2 Cheer Weeks: 1-12*3 Tumbling Weeks: 5-8, 11-12*4 Inline Weeks: 5-12*5 Skateboard Weeks: 1-12*6 BMX Freestyle Weeks: 1-12*7 Digital Media Camp: 3-12*8 Snowboard/Freeski Weeks: 3-12

FULL WEEKS ONLY3 week commitment. Please include 2 letters of recommendation from a teacher or coach.

Volunteer Positions: Dishroom Staff (must be at least 18 years old) Gym Junior Staff (must be at least 16 years old) Digital Media Intern (must be at least 16 years old)

Actual work dates are Saturday 1:00 P.M.Proceeding the session through Saturday7:00 P.M. No Exceptions!

C I R C L E D A T E S A V A I L A B L E

#1 June 3 – June 9 #7 July 15 – July 21#2 June 10 – June 16 #8 July 22 – July 28#3 June 17 – June 23 #9 July 29 – Aug 4#4 June 24 – June 30 #10 Aug 5 – Aug 11#5 July 1 – July 7 #11 Aug 12 – Aug 18#6 July 8 – July 14 #12 Aug 19 – Aug 25

FULL WEEKS ONLY

Actual work dates are Saturday 1:00 P.M.Proceeding the session through Sunday12:00 NOON of the following session. NoExceptions!

Please return this application by mail ASAP or by March 1 to:

PAGE 4

Personal Essay

We realize that a short application such as this one does not necessarily give an accurate picture of an individual. Please write a brief biographicalsketch that describes why you believe that you would be an asset to Woodward Camp and its campers, what contributions you think you can makeat camp, and/or what you believe a well-run camp can mean to children. If providing a photograph will help us recall who you are, please feel free toattach one to this application. Thank you.

I attest by my signature that I have never been convicted of any crime including sex-related or child-abuse related offenses.

I authorize investigation of all statements herein, including any checks of criminal records, and release the camp and all others from liability inconnection 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.

Signature ____________________________________________________________ Date ______________________________________________

How did you come to apply to Woodward? ________________________________________________________________________________________________________________________________________________________________________________________________________

Woodward CampP.O. Box 93, 134 Sports Camp Drive

Woodward, PA 16882ph 814-349-5633 fx 814-349-5643

Woodward Camp is an equal opportunity employer in accordance with the Civil Rights Acts of 1964 and all other federal, state, and local legislation on discrimination. We do not discriminate on the basis of race, color,religions, national origin, marital status, gender, or age. The information requested is needed for bona fide occupational qualification and no other purpose. All information contained herein is strictly confidential.

In case of emergency notify _______________________________________ _________________ ___________________ __________________Name Relationship Home Phone No. Cell Phone No.

Rev. Date 12/11#1010