Camp Pelican Online Application "Smiles and Friends Last Forever"
		Internet Note!!!!!! The submit function of this application is not yet functional. Please wait for further notice before attempting to send this application via the internet!   CAMP PELICAN XXV: The Silver Edition Staff Dates: June 1-8, 2002 Application Deadline: April 15, 2002  LA Lions - L.P.D.C.I. - Camp Pelican is a one week Summer Camp for children who have various pulmonary disorders (IE. Cystic Fibrosis, Chronic Asthma, Ventilator Dependancy and other lung disorders). Fr. R. Tony Ricard  has been the Camp Director of Camp Pelican for 18 summers. The following is an online application for anyone interested in becoming a staff member. The Staff positions are Staff Member, a Medical Staff Member, a General Counselor or a Counselor-in-Training for Camp Pelican. Camp Pelican is held in Leesville, LA, at the LA Lions Camp for Children. LA Lions Camp for Children Potential Camp Staff Member, This is our first attempt at providing and electronic application for camp staff members. At the end of the application process, please give us some feed back on this attempt. Thank you, Fr. Tony   Camp Pelican Staff Application 2002 First Name: MI Last Name: Street Address: Apartment # (If Applicable): City/State/Zip: E-Mail Address: Home Phone #: Work Phone #:  Social Security #: Driver's License #: State DL # Date of Birth: (MM/DD/YY) Age: Height: Weight: Sex( Check One):  Male or     Female Adult T-Shirt Size (Check One): Small-  Med-  Lg-  XL-  XXL-  XXXL-  XXXXL- Marital Status:   Single-       Married-       Divorced-      Other- Religion (Optional):  For what position are you applying? (Please Check One) General Staff:    -  Male General Counselor (Must be 17 years old by Camp)    -  Female General Counselor (Must be 17 years old by Camp)    -  Male Counselor-in-Training    - Female Counselor-in-Training   Activity Staff:   - Sports   - Arts & Crafts   - Waterfront (Swimming), Lifeguard   Medical Staff:   - Camp Doctor (MD)                        - Registered Nurse (RN)                                                                  - Nursing Student                                                                  - LPN   Respiratory Therapy Staff: -RRT       -CRTT      -CPFT/RPFT    -RT Student   Other Staff Positions: With what age group are you most comfortable working?  (Please Check One)   - 5 to 6 years old                         - 10 to 12 years old   - 7 to 9 years old                         - 13 to 15 years old -  No Preference                (It actually helps us if you DO have a preference) Do you have a pulmonary disorder or any disabilities which should be noted? - Yes      Specify: - No, I do not have a pulmonary disease. Are you a tobacco user (Smoking, Chewing, Skoal, etc.)?  - Yes   - No Have you ever been convicted of a crime (Excluding Traffic Offenses)?:  - Yes      - No If yes, please explain:   Do we have your consent to obtain a police report/employee security check about you from a local law enforcement agency? (Due to several national cases of pedophilia involving camp employees, we are now required to secure police checks for all camp personnel.) - Yes        Applicant's Social Security Number: (Please understand that in providing us with your Social Security Number in this section you are legally granting us permission to conduct a full police check on you.) - No If No, please explain: If you are a Minor (under the age of 18 years old), we must have you parent or guardian's permission to conduct a Police Check on you. That permission can be granted electronically by having your parent complete the following information. Parent or Guardian's Name: Parent or Guardian's Social Security #:                   Briefly describe your Educational background: (Schools, Dates Attended, Degrees, Present School Status, etc.) Please list your extracurricular activities or hobbies:  What courses have you had in camping, counseling, or first aid? What is you Swimming Level? - Beginner       - Intermediate   - Advanced - Teaching Ability          - Other - Current Employer  Company's Name:  Company Address:  City/State/Zip: Company Phone Number: Supervisor's Name: References (Do not include immediate family members): 1.  Reference Name:                         Phone:              Relationship:   2.  Reference Name:                          Phone:              Relationship:   3.  Reference Name:                          Phone:              Relationship: Previous Camp Experience Have you ever been a camper?:  - Yes    - No If yes, when & where?:  Were you ever a Camper at Camp Pelican? - Yes  If Yes, in what years? - No Have you ever been employed or volunteered for a Camp? - Yes                - No If yes, Please complete the following: Camp Name Camp Type Position Held Years  IE:Camp Pelican Pulmonary Counselor 4 years FOR RETURNING STAFF MEMBERS ONLY: How many years have you been a part of Camp Pelican's Staff? (Do not count this year):  Why do you want to return to Camp Pelican?:  The following questions are for NEW APPLICANTS: (Returning Staff may also reply) (1) What are your reasons for wanting to serve this type of camp?:    (2) Do you have any experience working with children? Explain:    (3) Have you ever worked with a chronically ill child? Explain:     (4) How did you find out about Camp Pelican?:   NEW APPLICANTS Please tell how you would deal with the following situations:  {A} A camper in your group will not follow the rules. What would you do?   {B} A camper complains of a sore throat but does not want to go to the infirmary for fear of being removed from camp activities.   {C} While in your company, a staff member spends a good deal of time "griping and complaining" about program management. CERTIFICATIONS AND LICENSES Please Bring Copies of these  Documents and Cards to Orientation (Please mark all that apply.) Medical Certifications/Licenses: -MD           -RN        -LPN     Other - Respiratory Therapy: -RRT          -CRTT       -CPFT/RPFT Other - First Aid:      Red Cross  - Expiration Date: - Other - CPR: - Red Cross Certified - Expiration Date: - American Heart Association - Expiration Date:   OTHER MEDICAL CERTIFICATIONS:   LIFESAVING/LIFEGUARD: - Advanced Lifesaving - Expiration Date: - Water Safety Instructor - Expiration Date: - Lifeguard Certification - Expiration Date: - Other: - Expiration Date:   ABILITIES, INTERESTS AND HOBBIES Please check all skill levels that apply to you. If you do not have any experience in a particular activity, please do not check anything for that activity. AREA I:  CAMP PROGRAM Campfire Programs Some Experience Teaching Ability Chapel Services Some Experience Teaching Ability Indian Lore Some Experience Teaching Ability Special Activities: such as Night Programs, Special Events, etc. Some Experience Teaching Ability Other - Some Experience Teaching Ability   AREA II:  FINE ARTS Singing Some Experience Teaching Ability Guitar Some Experience Teaching Ability Instrument - Some Experience Teaching Ability Dancing Some Experience Teaching Ability Drama Some Experience Teaching Ability Other - Some Experience Teaching Ability AREA III:  ARTS & CRAFTS Ceramics/Clay Art Some Experience Teaching Ability Drawing/Cartooning Some Experience Teaching Ability Painting Some Experience Teaching Ability Leather Craft Some Experience Teaching Ability Wood Work Some Experience Teaching Ability Found Objects Some Experience Teaching Ability Beading/Bead Work Some Experience Teaching Ability Other - Some Experience Teaching Ability AREA IV: CAMP CRAFTS AND SKILLS Animal Care Some Experience Teaching Ability Fishing Some Experience Teaching Ability Nature Games Some Experience Teaching Ability Entomology Some Experience Teaching Ability Overnight Camping Some Experience Teaching Ability Golf Cart Driving Some Experience Teaching Ability Maintenance Some Experience Teaching Ability Clerical/Office Work Some Experience Teaching Ability Other - Some Experience Teaching Ability AREA V:  AUDIO/VISUAL EQUIPMENT Sound Systems Some Experience Teaching Ability VCR Some Experience Teaching Ability 35mm Photography Some Experience Teaching Ability Dark Room Some Experience Teaching Ability Vidiography Some Experience Teaching Ability Other - Some Experience Teaching Ability AREA VI:  RECREATIONAL/ATHLETICS Tennis Some Experience Teaching Ability Putt-Putt Golf Some Experience Teaching Ability Bowling Some Experience Teaching Ability Basketball Some Experience Teaching Ability Volleyball Some Experience Teaching Ability New Games Some Experience Teaching Ability Archery Some Experience Teaching Ability Riflery (BB's) Some Experience Teaching Ability Other - Some Experience Teaching Ability Electronic Application Feedback: Please tell us what you think about being able to complete you camp application via the Internet. Do you have any suggestions as to how this process could be made any easier?   Before submitting your Application, please review all of you answers to make sure that they are accurate. Once you submit you application, there is no turning Back!!!!!!!!! Click the following Button to submit your online application.   Thank you for taking the time to complete your Application, you should be hearing from us soon, via email, letting you know that your application as been received and is being processed. And as always, Have a Nice Day! Fr. Tony, Camp Director