not initial

Age and gender are critical occupational qualifications for the following positions: Cabin Counselor/Activity Instructor, Trip Leader, Activity Specialist. If you are applying for one of these positions, please answer the following 2 questions:


If you are applying for a position other than counselor or trip leader, please answer the following:

Many positions at camp may require driving campers in camp vehicles. If you have a valid Driver's License, please enter that information:

(Please be as specific as you can. If you found us on the Internet, please tell us which job listing service or search engine you were using.)


(if different from above)
(if different from above)

At Which Address Can You be Reached for the Next Several Days?


Are you currently employed?

Do you have any physical or mental conditions that would affect your ability to perform the essential functions of your job with or without a reasonable accommodation? For example, our staff positions require that you be mobile over a variety of terrain and engage in physical exercise with campers. Answering yes will not necessarily disqualify you from employment but will instead allow us to consider the necessary accommodations

Current certifications you may have:

Certification: Expiration (mm/dd/yy):

What age group of campers would you like to work in a cabin group/live with?

Camp Skills

Activity Areas you are Qualified to Lead or Assist

Activity NameCan LeadCan AssistPlease explain your experience with this skill.

Experience with Kids

Work/Camp Experience

If you have ever worked in a children's camp before, please complete the chart below:

Camp #1 (most recent) Camp #2
Name of Camp
Location of Camp
Director Names(s)
Camp Phone
Your Years There (i.e. 1999 - 2001)
Last Position Held

Please list below any other jobs you have held, including the dates you were employed, the firm's phone number, and the name of the employer or direct supervisor whom we can call as a reference. Please list your most recent or current employment first.

Company Dates of Employment Phone Employer/Supervisor

Background Check

Please provide three persons (not relatives or significant others) who have knowledge of your character and ability. Please note that we must be able to contact these references by phone or email to consider you for a position.

Reference 1 Reference 2 Reference 3
Phone #

Your Internet Presence

The Internet is Public Space. This includes social networking websites. We are interested in protecting our campers, our camp reputation, and our staff. So that we can learn about your presence on the Internet, and view any of your postings that would be readily viewed by campers and parents, please list any sites you are present on, and any username or logon information we need to view those public spaces.

Site 1 Site 2 Site 3

By submitting this form to Camp Timberlane, you certify that you have never been convicted of a crime including crime against a child or children, and have never been dismissed from any employment for this reason. You give permission to Camp Timberlane to conduct criminal background evaluations at its discretion to confirm this information, to review your motor vehicle license record, and to review your public Internet postings. You further acknowledge that any future employment agreement between you and the camp is dependent on the satisfactory completion of these background steps. You understand that an electronic signature is required in signing an authorization allowing for the background check, and your submission of this application shall serve as written notification of your electronic signature. You agree to comply with Camp Timberlane's immunization policy requiring all staff to be vaccinated for MMR, Td/Tdap, Varicella, Meningococcal, and Hepatitis B.

If you agree with the statement above, please check the box prior to submitting this form. We know this application process is challenging, and we thank you for your time and interest.