Camp Preference : Pick one or more
Pick one:
Any camp
New Applicant
 Camp Prairie Schooner
Winding River Camp and Ranch
Camp Oakledge
Re-employment
Camp Daisy Hindman
 Camp Woodland
Personal Data
Last Name
 First Name
 Today's Date
Present Address
 Area Code/Phone #
City
 State
Zip Code
Permanent Address
Area Code/Phone #
City
 State
Zip Code
Area Code/Cell Phone
E-mail address
Best Way and Time to Reach You
Present Occupation or Year in School
Date of Birth (required if under age 19)
How did you hear about this job?
Position Information
Position/Type of Work Desired
Date Available
Were you previously employed by the Girl
Scouts of NE Kansas & NW Missouri?
 Have you previously applied to Girl
Scouts of NE Kansas & NW Missouri?
Yes
No
 Yes
No
Education and Training
Degree/Major
City and State
School Name
High School
College
Graduate
Other
List any classes, technical training, leadership or skill development related to the position you are applying for.
Describe any community, school, or other experiences that are related to the position you are applying for.
Certifications and Licenses
Check all that apply.  You will be required to submit photocopies of certification cards or documents prior to
beginning employment.
Lifeguard
Archery Instructor
First Aid
WSI
Ropes Instructor
Wilderness First Aid
Horsemanship
 Medical Doctor
 Adult CPR
Child CPR
Registered Nurse
Western
Valid Driver's License
English
Paramedic
Valid Chauffeur's License
Canoe Instructor
EMT
Valid Commercial Driver's License
Kayak Instructor
Physician Assistant
Sailing Instructor
Nurse Practitioner
Certifications and Licenses
Current or most recent employer
Area Code/phone #
Position
Address
Zip
State
City
Employment Dates (Month/Year)
Other Compensation
Name and Title of Supervisor
Reason For Leaving
Description of Duties
Previous employer
Area Code/phone #
Position
Address