DYLC Adult Application

Adult Application

Thank you for applying!

Please email your resume to nroquemore@dcsofsd.org
Date of Application*
MM slash DD slash YYYY
Name*
First Last
Preferred Pronoun
Birth of Date*
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Phone Device*
Email*
Driver License ID Number*
State*
Do you meet or exceed any minimum age requirements for that position? (If you are applying for the leader position, you must be 19 years old.)*
- Yes
- No
Are you fluent in American Sign Language?*
- Yes
- No
PAST WORK HISTORY
Provide a full record of all employment — paid and volunteer — and explain any gaps in employment. Include any position on camp staff. Use a separate sheet, it necessary. Your resume is not considered a replacement for this section.
Date*
MM slash DD slash YYYY
Employer/Supervisor*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Nature of Work*
Reason for Leaving*
Date
MM slash DD slash YYYY
Employer/Supervisor
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Nature of Work
Reason for Leaving
Date
MM slash DD slash YYYY
Employer/Supervisor
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Nature of Work
Reason for Leaving
Date
MM slash DD slash YYYY
Employer/Supervisor
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Nature of Work
Reason for Leaving
Indicate any employer you do not wish us to contact, and the reason
REFERENCE
Give names and addresses of three persons (not relatives) having knowledge of your character, experience, work habits, and ability.
Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
CAMP EXPERIENCE
Date
MM slash DD slash YYYY
Name of the Camp
Director Name
First Last
Address
City State / Province / Region Country
Position
- Camper
- Staff
Date
MM slash DD slash YYYY
Name of the Camp
Director Name
First Last
Address
City State / Province / Region Country
Position
- Camper
- Staff
Date
MM slash DD slash YYYY
Name of the Camp
Director Name
First Last
Address
City State / Province / Region Country
Position
- Camper
- Staff
Date
MM slash DD slash YYYY
Name of the Camp
Director Name
First Last
Address
City State / Province / Region Country
Position
- Camper
- Staff
EDUCATION
High School and Beyond
Years
School
Major Subjects
Degree Granted
Years
School
Major Subjects
Degree Granted
Years
School
Major Subjects
Degree Granted
Years
School
Major Subjects
Degree Granted
Years
School
Major Subjects
Degree Granted
Years
School
Major Subjects
Degree Granted
Years
School
Major Subjects
Degree Granted
Years
School
Major Subjects
Degree Granted
Write a brief biographical sketch, including specialized training in camping, and experience or training in other fields that might have a bearing on the position(s) for which you are applying.
CAMP PROGRAM SKILLS
n the following list, select a “T” before those activities you can organize and teach as an expert, and an “A” for those activities in which you can assist. Select a “C” after those in which you have current certification and attach a copy of your certification.
Arts/Crafts
Ceramics/Pottery
- T
- A
- C
Drawing/Painting
- T
- A
- C
Leather Craft
- T
- A
- C
Metal Work
- T
- A
- C
Photography
- T
- A
- C
Woodworking
- T
- A
- C
Drama
Clowning
- T
- A
- C
Theater
- T
- A
- C
ASL Storytelling
- T
- A
- C
Sports/Fitness
Baseball/Softball
- T
- A
- C
Basketball
- T
- A
- C
Lawn Games
- T
- A
- C
Soccer
- T
- A
- C
Volleyball
- T
- A
- C
Yoga
- T
- A
- C
Miscellaneous
Academics
- T
- A
- C
Aviation
- T
- A
- C
Community Services
- T
- A
- C
Farming/Ranching/Gardening
- T
- A
- C
Foreign Language
- T
- A
- C
Leadership Development/CIT
- T
- A
- C
Radio/TV/Video
- T
- A
- C
Storytelling
- T
- A
- C
Team Building
- T
- A
- C
Music/Dance
- T
- A
- C
Campcraft/Pioneering
Backpacking
- T
- A
- C
Campcraft
- T
- A
- C
Hiking
- T
- A
- C
Outdoor Cooking
- T
- A
- C
Overnights
- T
- A
- C
Wilderness Trips
- T
- A
- C
Nature
Animal/Animal Care
- T
- A
- C
Astronomy
- T
- A
- C
Birds
- T
- A
- C
Environmental Studies
- T
- A
- C
Flowers
- T
- A
- C
Forestry
- T
- A
- C
Insects
- T
- A
- C
Rocks/Minerals
- T
- A
- C
Weather
- T
- A
- C
CERTIFICATIONS AND CAMP SUPPORT STAFF SKILLS
In the following list, please select those items in which you have experience and skills. Select with a “C” those for which you hold current certification and email a copy of your certification to dylcamp@dcsofsd.org.
Business/Administration
Bookkeeping/Accounting
- T
- A
- C
Computer/Technical
- T
- A
- C
Computer/Software
- T
- A
- C
List of Computer/Software
Healthy/Safety
CPR
- T
- A
- C
First Aid
- T
- A
- C
Lifeguard
- T
- A
- C
Nursing
- T
- A
- C
Do you have any special accomplishments or skills that you would like to share with the campers?
- Yes
- No
If yes, please explain:
What contributions do you think you can give to the program?
HARASSMENT
The camp’s policy is to prohibit all forms of harassment by our employees and volunteers. This includes sexual, racial, religious, and 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 is not an automatic bar to employment. The type of accusation and when it occurred will be evaluated by the camp before any decision is made.)*
- Yes
- No
Explain:
CRIMINAL RECORD
Have 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 to employment or volunteer opportunties. The type of conviction and when it occurred will be evaluated by the camp before any decision is made.)*
- Yes
- No
Explain:
BACKGROUND CHECKS*
DCS involves the care of children and DCS reserves the right to conduct background checks on all applicants so as to ensure safety of all children during Literacy Camp. Background checks will be done before we offer you a position as a camp leader. I grant authorization to Deaf Community Services of San Diego, Inc. to do background check relative to the position for which I am applying and release Deaf Community Services of San Diego, Inc.
ACKNOWLEDGE*
ALL STATEMENTS MADE BY ME HEREIN ARE TRUE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT FALSE, MISLEADING OR OMITTED INFORMATION HEREIN ARE GROUNDS FOR DISMISSAL REGARDLESS OF THE TIME OF DISCOVERY BY THE DEAF COMMUNITY SERVICES OF SAN DIEGO, INC.
Please note that you will be required to attend orientation training prior to the camp. All statements become part of any future employee personnel files.

Deaf Community Services of San Diego, Inc.

Adult Application

Please email your resume to nroquemore@dcsofsd.org

PAST WORK HISTORY

REFERENCE

CAMP EXPERIENCE

EDUCATION

CAMP PROGRAM SKILLS

Arts/Crafts

Drama

Sports/Fitness

Miscellaneous

Campcraft/Pioneering

Nature

CERTIFICATIONS AND CAMP SUPPORT STAFF SKILLS

Business/Administration

Healthy/Safety

HARASSMENT

CRIMINAL RECORD

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