Use this form to apply for a position with our company. Please enter all information requested. Contact InformationEmail* Name* First Last Home Phone*Cell Phone*Work Phone*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Personal InformationDate of Birth* MM slash DD slash YYYY Position Applying For*Part-Time Stem Instructor/Science PresenterSite DirectorCamp CounselorJr. Camp CounselorWhy do you feel you would be a good fit for the position you are applying for?*Education InformationEducation Status*High school AttendeeHigh School GraduateAssociate DegreeBachelor's DegreeMaster's Degree or MoreHigh School/College Attended* Undergrad Major (NA for High School)* (Expected) Graduation Date* Graduate School Attended (NA for None)* Credentialed Teacher?* Yes No Do you have CPR Certification?* Yes No First Aid Certificate?* Yes No Work and Camp HistoryPlease give a brief description of your work experience relevant to the position you are applying. You may paste work history from your resume.*Please list your experience working with children in church, classroom or summer camp.*Describe an experience in which you were either part of or led a successful team. Describe the situation,the actions you took and the results. (max 200 words)*Describe an unforgettable teaching experience you have had with a child. (Max 200 words)*If you were a teacher or director of summer camp, what would your philosophy be? (Max 200 words)*References/General InformationList 2 professional references, at least one of which is a recent supervisor in a position relevant to this position:*NameRelationship to YouEmail AddressTelephone Number Who do you know who might be interested in learning more about Club SciKidz employment opportunities?*Have you applied for a position with our company before?* Yes No How did you hear about this employment opportunity?* If you were referred by someone, list them here:* Have you ever been convicted of a felony or misdemeanor?* Yes No Have you ever been involved in an incident involving sexual or physical abuse of a child?* Yes No Miscellaneous InformationDo you have any thoughts/comments about your preferred location? Please go to our website for after school or summer camp location preferences.*Do you have any physical conditions or diseases that would affect your abilities to perform all camp and classroom duties?* Yes No If yes, please explain:*What is your availability during the summer?* Certification and ReleaseTo the best of my knowledge and belief, the information given truly represents my background and experience. I understand that if I have knowingly or negligently misrepresented, falsified or omitted any information during the application process, I may be disqualified for employment consideration or dismissed from employment with Club SciKidz.* I agree to allow Club SciKidz to do a background check. CommentsQuestion or CommentsCAPTCHAPhoneThis field is for validation purposes and should be left unchanged.