BOY SCOUTS OF AMERICA WHEN COMPLETED, SUBMIT TO: DWC Camp Staff 571 Holt Avenue CAMPING SERVICES Manchester, NH 03109-5214 www.nhscouting.org/camping (Fax) 603-625-2467 603-625-6431 (Service Center) TODAY’S DATE: ______Email: [email protected] STAFF APPLICATION Daniel Webster Council Camps I am applying for (check any you wish to be considered for): Camp Hidden APEX Day Camp Carpenter Valley Camp Bell (year-round Cub World Camp program) CAMP CARPENTER CUB WORLD

BSA INFORMATION NAME: ______YOUTH ADULT UNIT #:______

ADDRESS: ______COUNCIL: ______

CITY: ______STATE: ______ZIP: ______DISTRICT: ______

PHONE: ______CELL: ______POSITION IN UNIT: ______

YOUR EMAIL: ______RANK EARNED: ______

PARENT EMAIL (18-): ______OA MEMBER? YES NO

SOC. SEC. #: ______AGE @ SUMMER START: ORDEAL – YEAR (OPTIONAL)

BROTHERHOOD – YEAR _____ EXPERIENCE AS A CAMPER (PLEASE LIST ALL YEARS ATTENDING FOR ALL CAMPS): VIGIL – YEAR _____ CAMP CARPENTER ______HIDDEN VALLEY ______CAMP BELL ______For each of the following completed, identify the year(s) on the line provided: CAMP______/YEARS ______|| CAMP______/YEARS _____ NATIONAL YTH LDR TRNG

EXPERIENCE AS A COUNSELOR-IN-TRAINING NYLT STAFF(S)

CAMP ______YEAR _____ CAMP DIRECTOR ______NAYLE

EXPERIENCE AS A VOLUNTEER STAFF MEMBER WOODBADGE

CAMP ______YEAR _____ CAMP DIRECTOR ______WOODBADGE STAFF(S)

JAMBOREES: NH / NATIONAL / WORLD / OTHER: EXPERIENCE AS A PAID STAFF MEMBER (PLEASE LIST ALL CAMPS / POSITIONS): ______YEARS _____ POSITION(S) ______CAMP______YEARS _____ YEAR(S) ______CAMP DIRECTOR ______YEARS _____

POSITION(S) ______CAMP______HIGH ADV.: PHILMONT / SEA BASE / SUMMIT / NORTHERN TIER / OTHER YEAR(S) ______CAMP DIRECTOR ______YEARS _____

POSITION(S) ______CAMP______YEARS _____

YEAR(S) ______CAMP DIRECTOR ______YEARS _____ Please rank desired positions from 1 (most desired) to 3, 4, 5+ (least desired) Minimum Camp Hidden Camp POSITION SPECIALIZED TRAININGS Age(s) Carpenter Valley Bell For each of the following completed, Camp Director 25 / 21 please indicate expiration dates (if applicable): Program Director 21 Head Commissioner 18 BSA Youth Protection ______Nurse / Health Officer 21 EMT (Emergency Medical Technician) 18 BSA National Camp School ______Business Manager / Asst. Res. Dir. 18 Adventure: Trek Leader / Trek Staff 21 / 18 Section ______All-Terrain Vehicles: Director / Inst. 21/ 18 Nurse / Health Officer ______Aquatics: Director / Asst. Director 21 / 18 Aquatics Instructor 16 Level ______Archery: Director / Instructor 18 / 15 BB Guns: Director / Instructor 18 / 15 Wilderness EMT (circle) / 1st Resp (circle) Brownsea: Director / Instructor 18 / 15 Challenge Valley 18 ______Climbing: Director / Instructor 21 / 18 Commissioner / SPOKE 18 EMT Level ______COPE (Ropes Course) Dir. / Inst. 21 / 18 COPE (Ropes Course) Instructor 15 Dining Hall: Director / Steward 18 Dining Hall Staff (Kitchen / Dish) 15 CPR (circle) / AED (circle) ______Ecology: Director / Instructor 18 / 15 Emergency Skills: Director / Inst. 18 / 15 Agency ______Farm (Equestrian) Director / Inst. 21 / 18 / 16 Basic First Aid ______FRONTIER! (First Year) Program 15 Fort Friendship: Director / Instructor 18 / 15 Agency ______Foxfire 18 Handicraft Director / Instructor 18 /15 Lifeguard ______Logging Camp 18 Mountain Man: Director / Instructor 21 / 18 Agency ______Native American: Director / Inst. 18 / 15 Nature 18 / 15 NRA Range Safety Officer ______Order of the Arrow Representative 18 Pirate’s Cove 18 / 15 Hunter Safety (State) ______21 / 18 Provisional Troop Scoutmaster Assistant 18 Leave No Trace (Master: Y / N ) ______Rifle Range 18 / 15

Scoutcraft: Director / Instructor 18 / 15 Other ______Shooting Sports (Firearms) Director 21 ______Sports: Director / Instructor 18 / 15 STEM: Director / Instructor 18 / 15 Other ______Support Srvcs:(Office/ Trading Post) 18 Webelos Woods: Director / Inst. 18 / 15 ______WoRM Area: Director / Instructor 18 / 15

ON A SEPARATE, TYPED, SHEET… PLEASE SUBMIT: I attest the information provided on this application is true to the best of my ability. I am aware Daniel Webster Council, , may share this information with others involved with the hiring process, only. I authorize Daniel Webster Council to contact 1) TWO PEOPLE AS REFERENCES (w/this info for each): references or others who know me for research regarding any positions for which I will be a) Name considered. I understand submittal of this application and participation in the interview process does not obligate Daniel Webster Council, Boy Scouts of America to hire me. If I am hired, I b) Relationship to you & how long they have known you am aware Daniel Webster Council, or myself, may terminate my employment at any time and c) Contact phone & email address for any reason with or without prior notification being given. 2) ANSWERS TO THE FOLLOWING QUESTIONS: a) What are your personal strengths and weaknesses? DATE______SIGNATURE______b) What are some of your non- interests/abilities? c) Why do you want to work in a Daniel Webster Council camp? Please include what you would like to learn, give DATE______SIGNATURE______to others and what makes you a good role model. Parent Signature required if applicant is under 18