Sample Page Name* First Last Social Security Number* Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone*Home Phone or Secondary Contact NumberDate of Birth* Month Day Year Email* Position Applying For:* General/Activities Staff Maintenance Crew Lifeguard Kitchen Staff Photographer Are you available for Weekend Shifts? (Check all that apply) May June July August September Are you available for weekday shifts in May and June? Yes No Have you previously worked at Black Bear Lake Camp or Picnics? If so, when? Educational Background High SchoolDates Attended School Degree CollegeDates Attended School Major Degree OtherDates Attended School Major Degree Past EmploymentList 3 most recent jobs. Employment Details 1Dates of Employment Company Name Address/Phone Responsibilities Supervisor Reason for Leaving Employment Details 2Dates of Employment Company Name Address/Phone Responsibilities Supervisor Reason for Leaving Employment Details 3Dates of Employment Company Name Address/Phone Responsibilities Supervisor Reason for Leaving References2 persons (not personal friends or relatives) having knowledge of your character, experience, and ability. Reference 1Name First Last Relationship Contact Number Reference 2Name First Last Relationship Contact Number Δ