Camp Staff Application

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

E-mail*

Phone*

Date of birth*

Gender*

County of Residence*

MN Diver's License Number or State ID Number*

List other names by which you have been known

List all other counties in which you have lived during the past five years

Emergency Information

Emergency Contact*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Relationship to you*

Health Care Provider*

Physician's Phone*

Insurance number

Please state any health information that might affect your job performance at camp.

Education History

High school name*

High school location*

Years attended high school*

Graduated?*

Yes
No

Name of college

Location of college

Major course of study

Years attended

Graduated?

Yes
No

Degree

Please note any extracurriculars and the dates in which you were active here.

Employment History

Please upload your resume here*

Drop files here or

Max. file size: 20 MB.

May we contact your current employer?*

Yes
No

Other skills

Please list any skills and/or experiences you have had which may have prepared you for a camp staff position with AuSM.

Work References

Please list complete information for one past supervisor and one person (not related to you) who has knowledge of your qualifications for this position. A reference form will be sent to individuals listed below.

Reference 1*

First Last

Title/relationship*

E-mail*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Occupation*

Reference 2*

First Last

Title/relationship*

E-mail*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Occupation*

Requested Camp Sessions

Please select all camp sessions at which you would like to work.*

Camp Discovery SESSION 1: June 11-16, 2022 (all genders, ages 17+)
Camp Discovery SESSION 2: June 25-30, 2022 (all genders, ages 10-16)
Camp Hand in Hand SESSION 1: June 21-26, 2022 (all genders, ages 20-24)
Camp Hand in Hand SESSION 2: June 27-July 2, 2022 (all genders, ages 15-19)
Camp Hand in Hand SESSION 3: Aug. 7-12, 2022 (all genders, ages 25+)
Camp Hand in Hand SESSION 4: Aug. 13-18, 2022 (all genders, ages 9-14)

Please note that the days of the week camp is held have shifted from prior years.

Which positions are you interested in working?*

Counselor
Volunteer
Program Staff (must have several years of experience working with individuals with ASD)
Nurse (RN, PA, or MD)

Additional Information

Select your t-shirt size*

AuSM is always seeking new venues to recruit camp counselors. Do you have any recommendations of organizations, groups, or locations where AuSM can share information about camp positions?*

Yes
No

Contact for organization*

First Last

E-mail for contact*

Where did you hear about AuSM camps?

Name of AuSM Staff

If other, please specify

Some camp families ask for contact information for camp staff that are interested in working as a PCA for their child after the camp season. Would you be interested?*

Yes
No

If you select yes, we will share your contact information.

Guidelines and Signature

Due to the COVID-19 pandemic, the AuSM team and partnering camps are working diligently on preparations for an adapted summer camp season. Keeping the safety of our community paramount and following the evolving pandemic regulations from the Centers for Disease Control and Prevention and the Minnesota Department of Health, we are being thorough and thoughtful in the planning process.

AuSM and partnering camp leadership will offer comprehensive training on safety protocols set for each camp, strategies and tools for support, and clear guidance regarding necessary changes to schedules or programming.

As the pandemic continues, regulations change daily. A complete list of guidelines for this 2022 summer camp season will be available in May. Below are possible precautions that will be put into place to keep our campers and staff as safe as possible.

AuSM and partnering camp locations reserve the right to make specific asks for staff to provide official copies of COVID-19 test results in a certain window and to minimize risk of exposure in the week before camp.
Staff must travel independently to and from camp.
Staff must be willing to have a daily forehead temperature taken.
Staff must be able to follow social distancing guidelines, wash hands and use hand sanitizer, and be willing to wear a mask.
Additional changes to elements of the camp experience may include meal service, sleeping quarters, activity offerings, and interaction with others.
Mask wearing may be required during staff free time/socializing.

I have read through the preliminary safety precautions that may be required of staff for the 2022 AuSM residential camps and agree to follow the requirements necessary for safety.*

Yes
No

An Equal Opportunity Employer

AuSM is an equal opportunity employer, and we do not and will not discriminate on the basis of race, religion, national origin, sex, age, handicap, marital status, or status as a disabled veteran. Information provided on this application will not be used for any discriminatory purpose. Your complete application form will be valid for the duration of the application calendar year. You may submit a new application at any time and are responsible to notify AuSM of any changes of address or other contact information.

Confidentiality

All information provided herein is considered confidential and will not be shared with any third party without consent.

Provide All Information Requested

I understand that all information provided herein will be subject to a Background Check, check of references and employer, and that my employment may be contingent upon receipt of an alien registration number, verification of birth, and any other pertinent information bearing upon my employment.

I hereby certify that the answers and other information on this application are true and correct. I understand that my continued employment depends upon the will of the company or myself.

By typing your name, you acknowledge it to be binding in substitution for your handwritten signature and it indicates your approval of the information contained.

Camp Staff Application

Summer Camp Staff Application 2022

Emergency Information

Education History

Employment History

Work References

Requested Camp Sessions

Additional Information

Guidelines and Signature

An Equal Opportunity Employer

Confidentiality

Provide All Information Requested