Camp Costanoan Application

Applicants for volunteer positions must be 16 years of age or older. Applicants for counselor, program or support staff positions must be 18 years of age or older. Thank you.

Personal Information

Date Current Address Expires

Earliest date you are able to begin employment

Latest date you are able to leave employment

Education and Experience

Please include name of school, year(s) completed, and any other pertinent information.

Please include name(s) and location(s) of school(s), year(s) and degree(s) completed, and any other pertinent information.

Please include name(s) and address(es) of program(s), position(s) and responsibilities held, dates worked, and contact information for any supervisors.

Please include all information about employer(s), position(s) and responsibilities held, dates worked, and any pertinent contact information.

More Information
Certifications
First Aid

Expiration Date

Expiration Date

Expiration Date

Expiration Date

Expiration Date

Expiration Date

Expiration Date

Expiration Date

Aquatics

Expiration Date

Expiration Date

Expiration Date

Languages applicant speaks and/or writes fluently (including Sign Language)

Please list the names, contact information, and any other pertinent information of at least two professional and/or character references

Eligibility

(If you are hired you will have to present evidence of your right to work in the United States no later than three days after the commencement of your employment)

If yes, state the nature of the crime(s), when and where convicted and disposition of the case. You may omit minor traffic offenses, any convictions which have been sealed, expunged or statutorily eradicated, convictions more than two years old for marijuana related offenses for personal use, and misdemeanors for which probation was completed and the case judicially dismissed.

(Conviction of a crime will not necessarily disqualify you from employment. Such factors as time of the offense, seriousness and nature of the violation and rehabilitation will be considered.)

Release of Information

I hereby authorize Via Services, Inc. and its agents to check references and confirm any educational degrees.

I release Via Services, Inc. and its agents from any and all liability, claims or lawsuits relating to Via Services, Inc.’s investigation and/or use of the information obtained from any and all of the above-referenced sources. I agree to defend, indemnify and hold harmless Via Services, Inc. from any and all claims or lawsuits which may result from Via Services, Inc.’s investigation or actions taken as a result of its research.

I understand that if I am hired, I will be required to provide documents which will verify my identity and eligibility to work in the United States, in compliance with the Immigration Reform and Control Act of 1986.

I understand that failure to reveal any prior employment I have had within the past ten (10) years or the providing of any false or misleading information may be grounds for immediate termination if Via Services, Inc. hires me, regardless of when Via Services, Inc. discovers the correct information.

I understand that all Via Services, Inc. employees are "at will" employees. This means that if I am hired by Via Services, Inc. I may resign my employment at any time, for any or no reason. Similarly, Via Services, Inc. may terminate my employment at any time, with or without notice, for any or no reason. No promise or representation contrary to the foregoing is binding on Via Services, Inc. unless made in writing and signed by the President & CEO of Via Services, Inc.