Phone: 608-348-9689
Fax: 608-348-9737
www.BadgerCamp.org

Wisconsin Badger Camp
PO Box 723
Plattevile, WI 53818

*Name: *Date:

*(Current) Street Address City State Zip

*(Permanent) Street Address City State Zip

*E-Mail Address: *Phone:

*To which address would you like us to send mail? Current Permanent

*Dates available to work:

How did you learn about Badger Camp? Poster on Campus Camp Fair
Online - Specifically: Other:

Skype Name: (Most interviews are conducted over Skype)

*Please check which position(s) you might be interested in:

Main Camp Counselor

Aquatics Director

Camping/Fishing Director

Primitive Camp Counselor

Nature Director

Garden/Petting Farm Director

Travel Camp Counselor

Recreation Director

Grounds Keeping

Head Cook

Arts & Crafts Director

Secretary

Dietician

Kitchen Assistant

Music Director

Health Care, Title Held:

*Education:

High School Did you graduate? Yes No

College Major

Employment Experience:

1) Employer's Name: Phone: 1) Employer's Address: Position: 1) Supervisor's name: Dates employed: 1) Reason for leaving:
1) Major Responsibilities:

2) Employer's Name: Phone: 1) Employer's Address: Position: 1) Supervisor's name: Dates employed: 1) Reason for leaving:
1) Major Responsibilities:

3) Employer's Name: Phone: 1) Employer's Address: Position: 1) Supervisor's name: Dates employed: 1) Reason for leaving:
1) Major Responsibilities:

* Required

Experience as a camper or a camp staff member:

Camp Name and Website
Position(s)
Year(s)
Supervisor

Volunteer and/or paid experience with people with special needs:

Organization/town/state/phone
Dates
Type of Work
Supervisor

Certificates/Trainings

Please indicate date of expiration and certifying agency:

*Valid Drivers License:

Yes No    (A driver’s license is not required, but please list information if current.)
Driver's License State Driver's License Number

Standard First Aid: Lifeguard Certification: CPR-Professional Rescuer: Water Safety Instructor: CPR Certification:
EMT Certification: First Responder: Licensed Practical Nurse Registered Nurse Sign Language: Fluency:
Other (please list)

*Have you ever been convicted (including a plea of guilty or no contest) of a crime (misdemeanor or felony) by a court, including a military court?
Yes: No: (If yes, list charge/date:)

*Are there felony charges pending against you?
Yes: No: (If yes, list charge/date:)

*Have you ever been accused of sexual abuse against a child or vulnerable persons?
Yes: No: (If yes, please describe in full:)

*Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status?
Yes: No: (If yes, please describe:)

* Required

QUESTIONAIRE

* Why did you decide to apply for a summer position at Wisconsin Badger Camp?

* Why do you feel you are qualified for the position(s) you are applying for?

* Why do you think that you are well-suited to work in a summer camp community?

* Why would you like to work for a program that provides services for people with disabilities?

* Some of our campers have been coming to camp for decades, why do you think camp is so important to them?

* What is your philosophy pertaining to individuals with developmental disabilities?

* Are you willing and able to work 24 hours a day, 5 ½ days a week for 11 weeks with minimal time off? Please be aware that many positions require you to share living space with campers.

* Are you willing to abide by strict policies concerning cell phone, smoking and alcohol use? Please explain any concerns:

*The positions at camp include heavy lifting (at least 60 pounds), strenuous activities, and long hours. Do you have any physical or mental limitations that would affect your job performance in the position for which you are applying?
Yes: No:
(If yes, please explain:)

*Have you applied for employment with Wisconsin Badger Camp before?
Yes: No:
(If yes, month and year:)

* Required

AGREEMENT

I certify that answers given herein are true and complete to the best of my knowledge.

I authorize investigation of all statements contained in this application for employment/volunteer work as may be necessary in arriving at an employment/volunteer work decision. I give permission for previous employers to share employment information.

In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand that Wisconsin Badger Camp will conduct background checks such as driving record, criminal history background, etc in association with this employment. I understand also that I am required to abide by all rules and regulations of Wisconsin Badger Camp. Any public social media content deemed inappropriate for working with campers or in conflict with camp policy may result in termination of candidacy.

I certify that I am/will be 18 years of age or older as of the first day of employment.


I have read and accept the terms of the agreement


Applicants for all positions at Wisconsin Badger Camp are considered without regard to race, color, religion, gender, sexual orientation, national origin, age, marital or veteran status, or the presence of a non-job related medical condition or disability.