2024 Application Employment Application PERSONAL INFORMATION Name (First & Last) * Date of Birth * Address * Address Address Address City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Home Phone Mobile Email * POSITION/AVAILABILITY (include resume if applying as instructor) Position you are applying for: * Instructor Counselor Jr. Counselor Resume * Drop a file here or click to upload Choose File Maximum file size: 104.86MB Check the weeks you are available. (Instructors MUST be available for all 5 weeks. Counselors and Jr. Counselors must be available for 2 weeks minimum; 3 weeks required to be eligible for a scholarship.) Week of July 3, 5, 6 & 7, 2023 AM PM Week of July 10 - 14, 2023 AM PM Week of July 17 - 21, 2023 AM PM Week of July 24 - 28, 2023 AM PM Week of July 31 - August 4, 2023 AM PM # of Years Sailed Last level of sailing completed Are you planning to enroll in any classes during the summer? Yes No (NYSS encourages employees to participate in classes when possible.) Skills and Qualifications Check all of these that apply. Include date of certification & certification number, if applicable, & date of expiration. US Sailing Level 1 Certification No Yes US Sailing Level 1 Certification Information US Sailing Level 2 Certification No Yes US Sailing Level 2 Certification Information First Aid / CPR certified No Yes First Aid / CPR certified Information State Safe Boating Certificate No Yes State Safe Boating Certificate Information US Sailing Counselor Certification No Yes US Sailing Counselor Certification Information LEGAL HISTORY Have you ever been convicted of a crime? No Yes Explain EMERGENCY CONTACT INFO Name * Phone * MEDICAL HISTORY Do you have any medical conditions which would affect your ability to perform your duties? No Yes Explain I certify that information contained in this application is true and complete. I understand that false information may be grounds for not hiring me or for immediate termination of employment at any point in the future if I am hired. I authorize the verification of any or all information listed above. Date Applicant Signature Parent’s Signature (if applicant is under 18) reCAPTCHA Email File Upload Drop a file here or click to upload Choose File Maximum file size: 104.86MB Star Rating star star_full 1 Star star star_full 2 Stars star star_full 3 Stars star star_full 4 Stars star star_full 5 Stars Time 121234567891011 : 0030 AMPM Section Section If you are human, leave this field blank. Submit Δ
