Wisconsin Badger Camp
Phone: 608-348-9689
Fax: 608-348-9737
www.BadgerCamp.org
PO Box 723
Platteville, WI 53818
2017 Staff Application
Name________________________________________________________
Date__________________________
Current Address ________________________________ Permanent Address ______________________________
__________________________________
________________________________
To which address would you like us to send mail:  Permanent  Current
E-Mail Address__________________________________________________ Phone __________________________
Dates available to work: __________________________________________
How did you learn about Badger Camp?  University Email  Poster on campus  Camp Fair
 Online – Specifically: ______________________
 Other: __________________________
Skype Name_______________________________________ (Most interviews are conducted over Skype)
Please check which position(s) you might be interested in:
Main Camp Counselor
Aquatics Director
Camping/Fishing Director
Primitive Camp Counselor
Nature Director
Garden/Petting Farm Director
Travel Camp Counselor
Recreation Director
Grounds keeping
Head Cook
Arts & Craft Director
Secretary
Music Director
Health Care, Title Held:______________
Dietician
Kitchen Assistant
Education
High School
College
Did you graduate?  Yes  No
Major
Employment Experience (list most recent experience first):
1. Employer’s Name: ___________________________________________ Phone: __________________________
Employer’s Address: _____________________________________________ Position: ____________________
Supervisor’s name: __________________________________________ Dates employed: _________________
Reason for leaving: ____________________________________________________________________________
Major Responsibilities: ________________________________________________________________________
2. Employer’s Name: ____________________________________________ Phone: _________________________
Employer’s Address: _____________________________________________ Position: ____________________
Supervisor’s name: _________________________________________ Dates employed: __________________
Reason for leaving: ____________________________________________________________________________
Major Responsibilities: ________________________________________________________________________
3. Employer’s Name: ____________________________________________ Phone: _________________________
Employer’s Address: _____________________________________________Position: _____________________
Supervisor’s name: ________________________________________ Dates employed: ___________________
Reason for leaving: ____________________________________________________________________________
Major Responsibilities: ________________________________________________________________________
References: (List 3 individuals NOT related to you who can judge your qualifications for this position)
Name/Relationship
Email Address
&
Phone
1. __________________________________________________________________________________________
2. __________________________________________________________________________________________
3. __________________________________________________________________________________________
Experience as a camper or a camp staff member:
Camp Name & Website
Position(s)
Year(s)
Supervisor
Volunteer and/or paid experience with people with special needs: (please list most recent first)
Organization/town/state/phone
Dates
Type of Work
Supervisor
Certificates/Trainings - Please indicate date of expiration and certifying agency:
 Valid Driver’s License  Yes  No (Driver’s License State and #)______________________________
(A driver’s license is not required, but please list information if current.)
 Standard First Aid
__________
 Lifeguard Certification ______________
 CPR – Professional Rescuer __________
 Water Safety Instructor ______________
 CPR Certification
_____________
 EMT Certification
______________
 First Responder
_____________
 Licensed Practical Nurse _____________
 Registered Nurse
_____________
 Sign Language: Fluency ___________________________
Other (please list): ____________________________________________________________________________________
Have you ever been convicted (including a plea of guilty or no contest) of a crime (misdemeanor or felony)
by a court, including a military court?  Yes  No
If yes, charge/date: ______________________________________________________________________________
Are there felony charges pending against you?  Yes  No
If yes, charge/date:______________________________________________________________________________
Have you ever been accused of sexual abuse against a child or venerable persons?  Yes  No
If yes, please describe in full: _____________________________________________________________________
Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status?
 Yes  No If yes, please describe: _____________________________________________________________
QUESTIONNAIRE
(Please attach another sheet, if necessary)
Why did you decide to apply for a summer position at Wisconsin Badger Camp? __________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Why do you feel you are qualified for the position(s) you are applying for? _______________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Why do you think that you are well-suited to work in a summer camp community?_________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Why would you like to work for a program that provides services for people with disabilities? ______________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Some of our campers have been coming to camp for decades, why do you think camp is so important to
them? ______________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
What is your philosophy pertaining to individuals with developmental disabilities? ________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Are you willing and able to work 24 hours a day, 5 ½ days a week for 11 weeks with minimal time off?
Please be aware that many positions require you to share living space with campers. ______________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Are you willing to abide by strict policies concerning cell phone, smoking and alcohol use? Please explain
any concerns: _______________________________________________________________________________________
____________________________________________________________________________________________________
The positions at camp include heavy lifting (at least 60 pounds), strenuous activities, and long hours. Do you
have any physical or mental limitations that would affect your job performance in the position for which you
are applying?  No  Yes If yes, please explain?___________________________________________________
____________________________________________________________________________________________________
Have you applied for employment with Wisconsin Badger Camp before?  No
If yes, month and year: ___________________________________________
 Yes
AGREEMENT
I certify that answers given herein are true and complete to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment/volunteer
work as may be necessary in arriving at an employment/volunteer work decision. I give permission
for previous employers to share employment information.
In the event of employment, I understand that false or misleading information given in my
application or interview(s) may result in discharge. I understand that Wisconsin Badger Camp will
conduct background checks such as driving record, criminal history background, etc in association
with this employment. I understand also that I am required to abide by all rules and regulations of
Wisconsin Badger Camp. Any public social media content deemed inappropriate for working with
campers or in conflict with camp policy may result in termination of candidacy.
I certify that I am/will be 18 years of age or older as of the first day of employment.
_____________________________________________
Signature of Applicant
___________________________________
Date
Applicants for all positions at Wisconsin Badger Camp are considered without regard to race, color, religion,
gender, sexual orientation, national origin, age, marital or veteran status, or the presence of a non-job related
medical condition or disability.