Iowa 4-H Center Junior Staff Application

Junior Staff Application

Can't commit for the whole summer? Junior Staff is a great position on our Iowa 4-H Camp Staff that allows for you to be on staff but not commit the whole summer. For more information email Abbie at aeparker@iastate.edu
Full Name*

First NameLast Name
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Click to edit
Phone Number*

Area CodePhone Number
Birth Date*

MonthDayYear
These are the dates I can be at staff training (check all that apply)

May 20-25May 28-June 1May 20-June 1 (I can be there for all of it!)I can be there for some of training, but not able to commit to dates right now
Check which dates you are available (check all that apply)*

June 2-8June 9-15June 16-22June 23-29June 31-July 3July 7-13July 14-20July 21-27July 28-August 4Aug. 4-7
Please list any certifications you have such as CPR, Lifeguard, ropes course, CNA, etc.
I would like to be certified as:

LifeguardClimbingCPR/First Aid
Indicate any areas of expertise such as archery, arts & crafts, aquatics, nature, etc.
List any hobbies or special interests you have that might prove beneficial to you as a camp counselor
Please describe something you've done at work, school, while volunteering, that you are especially proud of
Please Read & Sign

I hereby attest to the accuracy of the information I have provided. I authorize the camp to investigate the statements herein, including background checks, work history, and driving records, and release the Iowa 4-H Center and all others from any associated liability. I understand that any misrepresentation or omission may be grounds for discharge whenever discovered. I further acknowledge that any employment with the Iowa 4-H Center is contingent upon satisfactory clearance of my criminal history and driving record. I waive my right to review references or recommendation, understanding that their contents are confidential and will not be available to me now or in the future. I am familiar with the general characteristics of the Iowa 4-H Center, the program offered, and the campers attending.
Do you agree with the statement above?*

Yes -- I agree and accept
Should be Empty: