Staff Application Questionnaire

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) *

Every 11th Grader has a fee of $1200 please submit CC information below. Upon acceptance card will be charged.

Credit Card Number *

Expiration Date (mm/yy) *

CVV Code *

Billing Zip Code *

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)

Strength and Ability Assessment:

We will now ask you to rate your strengths and abilities in specific areas.

STRENGTHS AND ABILITIES tell us what you are good at, they focus on your personal skills.

This is how we want to get to know you and determine what job you would be best at in our camp. Please put thought into how you complete these assessments, but do not spend an excessive amount of time on it. The entire assessment should take no longer than 15 minutes.

Strengths and Abilities - Part I

Below is a list of abilities/personal strengths. Please number them in order of your capabilities from 1-7, (1 means you excel in this area, and 7 means you have no capabilities in this area at all, all other numbers falls someplace in between. Use each number only 1 time.)

	Outdoor Sports (Basketball, machanayim, baseball etc)
	Art / Craft (Drawing and Painting)
	Swimming (Strokes and Lifeguarding)
	Dance/Gymnastics
	Gourmet Baking/Cooking (Cookie decorating, fruit displays etc
	Musical Ability (singing &/or playing an instrument)
	Stage performing

For the two or three areas you excel at the most, in the list above, please tell us any past experience, in which you were involved in these areas.

Strengths and Abilities - Part II

Below is a second 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

For the two or three areas you excel at the most, in the list above, please tell us any past experience, in which you were involved in these areas.

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; 9 is the job you want least; all other numbers fall someplace in between). Every box needs a number to submit the form.

	Mother’s Helper (watching babies and young children)
	Bunk Miriam (counselor for 6-10 year old girls)
	Daycamp (counselor for 2-6 year old children)
	Daycare (counselor for ages 0-2)
	Indoor Assistant (Crafts/Food Décor/Baking)
	Junior Counselor (trip 2 only)
	Lifeguard (Choose this only if you will have valid lifeguard and CPR certification by May 15, 2025. To be valid, lifeguarding certification must be after August 26, 2023 and CPR certification must be after August 26, 2024. If you do not qualify put this as #9.
	Outdoor Assistant (Sports/Special Activities)

Job Preference #2

In addition to your primary job you will also have a secondary job. Please list your preferances below, in order of the job you want most to the job you want least (1 is the job you want most; 7 is the job you want least; all other numbers fall someplace in between).Every box needs a number to submit the form.

	SongDance
	Dance
	Daily Backdrop
	Acting Choir
	Choir
	Props
	Lighting
	Sets
	Library

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? *

4. 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)