Please Fill Out & Complete All Fields

Winter Address:
PO Box 202
Roxbury, CT 06783
(514) 369-3654 voice
(888) 487-3866 toll free
(514) 369-6493 fax
 Toll free:
1.888.ITS.FUNN (487.3866)
voice (US & Canada only)

Email:
dovshapiro@chateaugay.com		 Summer Address:
233 Gadway Road
Merrill, NY 12955
518.425.6888 phone
518.425.3487 fax

Please print "N/A", (not applicable) in any space which does not apply to you.

We recognize that completing this application is an investment of your time and yourself, so we want to express our appreciation in advance.


Dear Prospective Staff,

Thank you for your interest in Camp Chateaugay. Our camp is unique and we strive to be the best experience for both campers and staff. Our wide geographic mix, individual scheduling and instruction, and caring staff create memories for a lifetime for all.

Our staff training begins in mid June, and our campers arrive towards the end of June. There are five 24 hour days off during the summer, and our staff often goes to nearby Montreal, Quebec, Burlington, Vermont, or Lake Placid, New York for days off. All are within an hour and a half from camp.

We are anxious to get your application so please review the material, fill out our application and we will review it as soon as it arrives via email. To ensure its arrival, please call us within 48 hours to follow up at 1-800-487-3866.

Camp Chateaugay
PO Box 202
Roxbury, CT 06783
Or fax to: 514-369-6493

I will be back in contact with you soon. New York State Law require that we get written references so please include address and phone numbers with your references. Also please send a copy of any certification cards. As a final process of hiring we will be doing national background checks.

Sincerely,

Dov Shapiro
Director


PERSONAL INFORMATION

 
Name:   Today's Date:   Home Phone:             Cell phone:
      
         
Home Address:   School Address:   School Phone:
 
         
E-mail:   Date of Birth:   Birthplace:
   
         
Citizen of:   Height:   Weight:
   
         
Marital Status:   Children:   College, Graduate School, Etc:
   
         
Last Year Completed:   Major(s) and Minor(s):   Camp Experience as Camper:
   
         
Camp Experience as Counselor:   Current Job held and Experience:   Previous Work Experience:
   
         
Do you speak any language other than English and how well?   Can You Drive a Car?   Can You Drive a Motor Boat?
   
         
Do You Have any Driving Convictions within the Last Four Years?
If so, please list : 		 
 
   
Are there any special conditions, communicable diseases, problems, or limitations?
(including physical or mental impairments) which might interfere with your ability to perform the job for which you are applying? If yes, please explain : 		 
 

ACTIVITIES
In the following list put a number 1 before those activities that you can organize and teach as an expert; 2 for those activities which you can assist in teaching; and 3 for those in which you have useful experience as a participant.
         
LANDSPORTS   WATERSPORTS   ARTS AND CRAFTS
       
Archery
 
Canoeing
Woodworking
Basketball
 
Kayaking
 
Candle Making
Baseball
 
Life-guarding
 
Wheel Throwing
Roller Hockey
 
Motorboat
 
Ceramics
Field Hockey
 
Rowboats
 
Copper Enamel
Golf
 
Sailing
 
Drawing
Martial Arts
 
Diving
 
Jewelry
Gymnastics
 
Swim instruction
 
Leather
Tumbling
 
Wake Boarding
 
Macrame
Horseback Riding
 
Water-skiing
 
Model Making
Lacrosse
 
Wind-surfing
 
Painting
Soccer
 
WSI
 
Paper mache
Tennis
 
OTHER:
 
Printing
Volleyball
     
Puppetry
Weight Training
     
Stained Glass
OTHER:
     
Basketry
       
OTHER:
         
PIONEERING   OFFICE   MUSIC
         
Camp Craft
 
Typing
 
Song Leading Piano
Cycle Tripping
 
Book Keeping
 
Accompany
Hiking
 
Computer Skills
 
Classical
Outdoor Cooking
 
Data Entry
 
Pop
Overnight Tripping
 
Windows
 
Site Read
Rock Climbing
 
DOS
 
Transpose Other
Ropes Course
 
Word Processing
 
Bugle
OTHER:
 
Spread Sheet
 
Drums
   
OTHER:
 
Guitar
       
OTHER:
DANCE   MISCELLANEOUS    
         
Aerobic
 
Circus Arts
   
Ballet
 
Animal Care
   
Choreography
 
Film/Video
   
Jazz
 
Fishing
   
Modern
 
Martial Arts
   
Musicals
 
Magic
   
Tap
 
Archery
   
OTHER:
 
Roller-Blading
   
   
Set Construction
   
   
Astronomy
   
   
Sciences
   
   
Ham Radio
   
   
OTHER:
   
CAMP ACTIVITIES
Please identify which skill area(s) you are interested in teaching and briefly write your proficiency, including qualifications gained, teams, offices held, honors or trophies received, etc.
 
Skill 1
 
Skill 2
 
Skill 3
 
We have some strict guidelines with regard to tobacco smoking. Do you smoke and if so, are you willing to work in an environment that only allows for smoking at certain times in certain places?
Smoking:
REFERENCES/EXPERIENCE/BACKGROUND INFORMATION

References are an important part of our consideration of your application and we ask that you supply the names of three individuals who may be contacted for this purpose. Please select individuals that have first hand knowledge of your experience and skill level in the activities which you previously listed as your preferences. If applicable, we would prefer you provide the name(s) of your immediate supervisors in organizations working or associating with children.

Each reference should include the name of the organization for which you worked, the address and the telephone number, along with the name of the individual to be contacted. Please briefly describe your relationship with this person and describe your responsibilities, the age group with whom you worked, dates of employment, salary, and any other pertinent information.

These individuals will be contacted in order to help us get a sense of you and your qualifications for the position at Camp Chateaugay.

 
Reference 1
 
Reference 2
 
Reference 3
CERTIFICATIONS
Do you currently have American Red Cross, YMCA/YWCA, or American Heart Instructor Certification in the following area?
WSI   Canoeing
CPR   BLS
First Aid   Lifeguarding
Sailing   Community CPR
 
Aquatics/Small crafts school attended? Dates:
 
Describe any First Aid courses you have completed and certifications you have received:
 
Describe any awards, certificates, courses, etc. which you consider to be relevant to this application
 
Please include a brief biography, including year by year work history with dates and phone numbers for verification.
Explain any gaps in employment.
 

Please describe your reasons for applying for the position at Camp Chateaugay. Include what you feel are your qualifications/characteristics which enable you to effectively fulfill your position at camp. Also, use this opportunity to share any valuable information about yourself that will aid in the consideration of your application.

 
How did you learn of Camp Chateaugay?
 
What is the approximate salary expected?
The information contained in this application will be held in strict confidence. Should we be unable to consider you for a position, do you wish us to refer your application to another camp or camps?
Yes   No
 
Have you ever been arrested for or convicted of a felony, child abuse or sexual misconduct/abuse? If yes, please explain
 

I HEREBY STATE THAT THE FOREGOING INFORMATION IS TRUTHFUL AND ACCURATE AND IS TO BE CONSIDERED AN INTEGRAL PART OF ANY CONTRACT I MAY ENTER INTO FOR EMPLOYMENT AT CAMP CHATEAUGAY.

Applicant's Signature (enter your name)
Date submitted
 
Please mail or E-mail (chateaugay@aol.com) a recent photo of yourself to Camp Chateaugay.