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EMPLOYMENT APPLICATION PROCESS Please complete the forms below1. Employment Application2. Photo Authorization Form3. Background Investigation Consent Form4. Swim Background Information Return as soon as possible to:Purchase Day Camp3095 Purchase StreetPurchase, NY 10577 Wait for a response letter from Purchase Day Camp If an interview has been approved, call (914)949-2636 to request anappointment. Return the three (3) Reference Forms, provided with the interview requestletter, prior to the interview date.
Name(Last)AddressHome Phone (Social Security #(Street))-Date(First)Cell Phone (-)(City)(State)BirthdatePresent OccupationSexMale(Zip)FemaleE-mail AddressEDUCATIONName of SchoolCurrent Year orLast Year CompletedDid YouGraduate?Year GraduatedDegree Received Or Current Major1 2 3 4YesNoCollege1 2 3 4YesNoPost College1 2 3 4YesNoTrade School1 2 3 4YesNoEXPERIENCEList PAID EXPERIENCE in order of most recent position.ORGANIZATIONTYPE OF WORKDATESEMPLOYERPHONE NUMBER1.2.3.List any VOLUNTEER EXPERIENCE you have had.1.2.3.What related experience with children have you had? Teaching, recreation, babysitting, etc. (include ages and gender)CERTIFICATIONS - Please indicate any current certifications you have by filling in the expiration date below.AMERICAN RED CROSS/YMCA CERTIFICATIONSOTHER CERTIFICATIONSLifeguard TrainingLifeguard Training InstructorResponding to Emergencies (RTE)Community CPRTeacher CertificationRN/LPN CertificationWater Safety Instructor (WSI)CPR for the Professional RescuerEMT CertificationStandard First AidOther (specify)Other (specify)Be sure to complete reverse sideEmployment ApplicationHigh School
CHARACTER AND REFERENCESList 3 people who know of your work such as teachers, employers, etc. No family members please.NAMEADDRESSPHONE NUMBER1.2.3.Have you ever been charged, either criminally or civilly, with sexual abuse, sexual harassment or discrimination? YesHave you ever been convicted of a felony? YesNoIf you answered Yes to either of the last two questions, please llenge CourseTennisGolfDanceGymnasticsGaGa BallArts & rciseCookingRocketryTheatreVideo ProductionOtherSUMMER POSITIONSCheck position you are applying for:General CounselorAge group preference:Specialty Counselor3-4 Year OldsIndicate your swimming ability:Waterfront5-6 Year OldsNon-SwimmerFood Service7-8 Year OldsBeginnerMaintenance9-10 Year OldsIntermediateWhat experience, if any, do you have teaching swimming?What general camp experience have you had, if any? Describe.Are there any obligations requiring you to need time away from summer camp?AFTER SCHOOL POSITIONSCheck position you are applying for:Area SupervisorClass InstructorClass AssistantAge group preference:5-6 Year Olds7-8 Year Olds9-10 Year OldsSignatureDateNurse11-13 Year OldsAdvancedEmployment Application (page 2)ACTIVITIES - Check once the activities below that you like to do. Check twice those activities that you could teach or help teach.
Photo Authorization FormI give permission for The Purchase Community Inc., to take my picture and include it with myapplication.Print NameSignatureDate/ /
Background Investigation ConsentI, , hereby authorize the Purchase Community Inc. and/or itsagents to make an independent investigation of my background, references, character, past employment, education, credithistory, criminal or police records, including those maintained by both public and private organizations and all public recordsfor the purpose of confirming the information contained on my Application and/or obtaining other information which may bematerial to my qualifications for employment now and, if applicable during the tenure of my employment with the company.I release the Purchase Community Inc. and/or its agents and any person or entity, which provides information pursuant to thisauthorization, from any and all liabilities, claims or law suits in regards to the information obtained from any and all of theabove referenced sources used.The following is my true and complete name and all information is true and correct to the best of my knowledge.Legal First Name (PRINT PLEASE)Middle NameLast NameHouse/Apt # Permanent Home AddressStateZip- - ( ) - ( ) -Social Security #Phone #Cell Phone #/ /*Date of Birth:CityCounty (i.e. Westchester, Dutchess)Driver’s License #andState IssuedEmail Address*NOTE: The above information is required for identification purposes only, and is in no manner used as qualifications foremployment. The Purchase Community Inc. is an Equal Opportunity Employer, and does not discriminate on the basis of Sex,Race, Religion, Age, Handicap or National Origin.I understand that my failure to complete this form will cause me to forfeit the opportunity to interview for a position at thePurchase Community Inc.SignatureDate / /Signature of Parent/Guardian if under the age of 18 Date / /
NameAge1. Are you comfortable in the water?Phone (Yes)No2. Have you taken and passed any American Red Cross (ARC) or Purchase Day Camp (PDC) Learn to SwimProgram Levels?YesNoIf yes, check highest level passed:ARC Level NamesWater ExplorationPrimary SkillsStroke ReadinessPDC Level NamesWaterbugPenguinSealLevel 4Level 5Stroke DevelopmentStroke RefinementSea LionSailfishLevel 6Skill ProficiencyPorpoiseLevel 7Advanced SwimmerKingfishLevel DescriptionWater entry and comfortFloat without support, locomotion skillsFront & back crawl, tread water, diving,safetyDevelop confidence in learned strokesIntroduction of butterfly, feet-first andspringboard divingPolish all swim strokes with ease,Smoothness and distancePerfect strokes, advanced rescue skillsIf you have not taken or passed any of these levels, what would you feel your swim level is now based upon thedescriptions?3. Have you ever taught swimming?Where?What level? (use description above)How many years?4. What Purchase Day Camp Level of Swimming would you feel most comfortable teaching?Check one:L1L2L3L4L5L6L75. Have you taken and passed any of the following Certification Courses? If so, indicate the expiration date.LGTWSISFAOtherEMTRTECPR for the Professional RescuerI understand that as a counselor, I will be asked to teach or help teach swimming instruction at PurchaseDay Camp./Signature/DateSwim Background InformationLevel 1Level 2Level 3
AGE/GRADETITLEMIN. EXPERIENCE, EDUCATION & CERT.SALARY2022LUNCH IS INCLUDED FOR ALL TEAM MEMBERS. ADDITIONAL BONUS FOR WORKING ALL 8 WEEKS.Counseling TEAMSH.S. SophomoreH.S. JuniorH.S. SeniorCollege FreshmanCollege SophomoreCollege JuniorCollege Senior & UpCollege Junior/SeniorCollege GraduateAssistant Counselor IIAssistant Counselor IIIAssistant Counselor IVSenior Counselor ISenior Counselor IISenior Counselor IIISenior Counselor IVTEAM Leader ITEAM Leader II1 Yr. Experience Preferred2 Yrs. Experience Preferred2 Yrs. Experience Preferred2 Yrs. Experience (Subjective) plus 1 Yr. College Preferred2 Yrs. Experience (Subjective) plus 2 Yrs. College Preferred3 Yrs. Experience (Subjective) plus 3 Yrs. College Preferred3 Yrs. Experience (Subjective) plus 4 Yrs. College Preferred2 Yrs. (Subjective)Teacher Certification 900 1,200 1,500 1,800 2,100 2,400 2,800 3,500 4,000Activity LeaderCollege Junior/SeniorCollege GraduateActivity Leader IActivity Leader II2 Yrs. in Specialty (Subjective)Teaching Certification 3,700 4,200Swim LeadersH.S. Sophomore & 16H.S. Junior & 17H.S. SeniorCollege FreshmanCollege SophomoreCollege JuniorCollege Senior & Up17 to High School SeniorCollege FreshmanCollege SophomoreCollege JuniorCollege Senior & UpCollege Senior & UpSwim Leader IISwim Leader IIISwim Leader IVSenior Swim Leader ISenior Swim Leader IISenior Swim Leader IIISenior Swim Leader IVWater Safety Instructor IISenior Water Safety Instructor ISenior Water Safety Instructor IISenior Water Safety Instructor IIISenior Water Safety Instructor IVSwim Program SupervisorLGT, CPR for Prof. Rescuer & SFALGT, CPR for Prof. Rescuer & SFALGT, CPR for the Prof. Rescuer & SFALGT, CPR for the Prof. Rescuer & SFALGT, CPR for the Prof. Rescuer & SFALGT, CPR for the Prof. Rescuer & SFALGT, CPR for the Prof. Rescuer & SFAWSI, LGT, CPR for the Profess. Rescuer & SFAWSI, LGT, CPR for the Profess. Rescuer & SFAWSI, LGT, CPR for the Profess. Rescuer & SFAWSI, LGT, CPR for the Profess. Rescuer & SFAWSI, LGT, CPR for the Profess. Rescuer & SFAWSI, LGT, CPR for the Profess. Rescuer & SFA, Teaching Cert. 1,400 1,700 2,000 2,300 2,600 2,900 3,300 2,250 2,550 2,850 3,150 3,550 4,000Camp NurseCollege GraduateMaintenance StaffH.S. Sophomore & 16H.S. Junior & 17H.S. SeniorCollege Freshman & UpRN License, CPR for the Professional Rescuer & Responding to Emergencies Required**See Below** Highly competitive salary based on certifications and experienceMaintenance Assistant IIMaintenance Assistant IIIMaintenance Assistant IVSenior Maintenance AssistantMaintenance Experience PreferredMaintenance Experience Preferred1 Yr. Experience with Lawn Equip. plus Drivers License2 Yrs. Experience with Lawn Equip. plus Drivers License 1,400 1,700 2,000 2,300 Min.Please Note: Bus Monitoradd 500 WSI Certification For Non‑Swim Specialist TEAM Membersadd 250 Lifeguard Training Certification For Non‑Swim Leader TEAM Membersadd 250 Emergency Medical Technician (E.M.T.)add 250 ARC Responding To Emergencies Plus CPR For The Professional Rescueradd 250 All Grades Refer to the year completed immediately prior to the camp season. Waterfront and other Certification requirements are subject to change by the State Health Department. All Minimum State Certification requirements will be observed. Camper Enrollment Benefit: Fees for TEAM Member children will be deducted from the employees’ gross salary at a rate of 1000 per child.
College Senior & Up Senior Counselor IV 3 Yrs. Experience (Subjective) plus 4 Yrs. College Preferred 2,800 College Junior/Senior TEAM Leader I 2 Yrs. (Subjective) 3,500 College Graduate TEAM Leader II Teacher Certification 4,000 Activity Leader College Junior/Senior Activity Leader I 2 Yrs. in Specialty (Subjective) 3,700
