Chaviva Child Care

Staff Member Last Name *

Staff Member First Name *

Trip? *

Current Grade *

Home Phone
(If you do not have a home phone
write N/A, do not use cell number) *

School Currently Attending *

Camp attended last year *

Cell Number *

Text Enabled *

Yes

Date of Birth * +

Email Address *

Address *

City *

State *

Zip *

Father Title

Father(First Name Only)

Father's Cell Phone

Father's Email Address

Mother Title

Mother(First Name Only)

Mother's Cell Phone

Mother's Email Address

Marital Status *

Mothers Maiden Name *

Shul Affiliation *

Emergency Contact Name

Emergency Contact Number

Staff Picture (Head Shot) (For those with a smart phone the picture can be taken and attached directly now) *

Please tell us how you spent your last four summers both first and second halves….

2024 *

2023 *

2022 *

2021 *

Please check off which of these years you were in Camp Chaviva:

2024 (TC)

2023 (Sarah CIT)

2022 (Rochel)

2021 (Leah)

Strengths and Abilities

Below is a list of abilities/personal strengths. Please number them in order of your capabilities from 1-6, (1 means you excel in this area, and 6 means you have less capabilities in this area, all other numbers falls someplace in between)

	Relating to Youngsters
	Team Player
	Leadership
	Organization
	Compassionate caregiver
	Peacemaker

Job Preference

Please number them in order of the job you want most to the job you want least (1 is the job you want most; 3 is the job you want least). Every box needs a number to submit the form.

	Kinder Crew (mother's helper for babies and young children)
	Chaviva Gems (counselor for ages 0-2)
	Bunk Dina (counselor for 2-6 year old children)

General Questions

1. What is your greatest personality asset working with kids? *

2. What makes you a good role model for a Camp Chaviva camper? *

3. If I asked someone you worked with in the past what your greatest strength is, what would they say? *

Please list at least two (up to four) girls you would want to work with in any job we assign to you.

Prioritize

What would be most important to you when working in a staff job? (Please list in order of importance, 1 is most important and 3 is least important)

	Working with friends
	Working at something you love
	Working at something you’re good at.

References

If you have not been in Camp Chaviva for the past 2 summers we need 3 references. At least 1 of these references need to be from your camp this previous summer. If this does not apply to you please write N/A in each field.

Reference Name (1) *

Reference Cell Number (1) *

Relationship to applicant (1) *

Reference Name (2) *

Reference Cell Number (2) *

Relationship to applicant (2) *

Reference Name (3) *

Reference Cell Number (3) *

Relationship to applicant (3) *

Memo (Please add any information we should know)