Staff Application Questionnaire

Staff Member Last Name *

Staff Member First Name *

Date of Birth * +

Trip? *

Current Grade *

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

Current Job *

Camp attended last year *

Cell Number *

Text Enabled *

Yes

Have you ever been a staff member
in Camp Chaviva before? *

What High School did you attend? *

What Seminary did you attend? *

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 *

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

	Counselor/Supervisor
	Singing Counselor/Shiur/Special Activity
	Night Activity Heads/Shiur/Special Activity
	Daycamp (counselor for 2-6 year old children)
	Daycamp (counselor for 0-2 year old children)
	Bunk Miriam (counselor for 6-10 year old girls)
	Mother’s Helper (watching babies and young children)
	Office/Technical Assistant/Shiur
	Head Waitress/Kitchen Help
	Nurse’s Assistant (Helping in the Infirmary)
	Administrative Assistant/Shiur
	Play Assistant for all areas of Major Play

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

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)