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REQUEST INFORMATION | SUMMER 2007 PHOTOS | HOME
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 Summer Camp Nurse Job Application
Name: Soc. Sec. #:

Home Address:

Home Phone:

Present Address (if different):

Phone (if different):

E-mail Address:
How did you hear about Kippewa?
If Advertising or Job Listing - Where?
If Other - Explain:
 
Nursing School: Year Graduated:
Degree (RN - LPN - NP):
Which states are you licensed in?
License Number:
 

Employment Experience:

Dates:
Hospital Supervisor:
Phone:
Address:
Dates:
Hospital Supervisor:
Phone:
Address:
Dates:
Hospital Supervisor:
Phone:
Address:
 

Additional References:

Name: Phone:
Address:

Name: Phone:
Address:

Name: Phone:
Address:
 

Prior Camp Experience:

Dates:
Supervisor: Phone:
Address:

Dates:
Supervisor: Phone:
Address:

 
 Please describe in detail any experience you have working in pediatrics?
 Do you have Emergency Room experience?
 What qualities do you bring to camp that will make you an asset to our community?
 How would you describe your assessment skills?
Are you Flexible and willing to work long shifts if necessary?

Do you have children/spouse that will accompany you to camp (age/sex)? Do they have any special needs (diet / medication / housing)?

Please list any certification you presently hold such as CPR, PALS, ACLS:
 Please add any additional comments you may have:
The statements in this application are true, complete and correct. I understand that any misrepresentation or omission of information shall be considered sufficient reason for withdrawal of an offer or subsequent termination of employment. I hereby authorize Camp Kippewa to conduct a personal felony record search.

By electronic submission of this application to Camp Kippewa, I understand and agree to the conditions stated above.


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Kippewa for Girls • Visit our brother camp – CAMP COBBOSSEE, a boys summer camp

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