Staff Application

 
Personal Information: 
First Name:
Last Name:
Social Security Number:
Gender:
Male Female
Home Address:
School Address:
Home Phone:
School Phone:
Email Address:
Position Desired:
Date of Birth:
Age as of July 2007:
Height:
Weight:
Marital Status:
Do you Have Children?
Yes No
If so, please list
their ages and sex:
Any physical handicaps?
Yes No
If so, please explain:
Minimum salary desired for 7-week season:
Fall Date of College Registration:
Can work untill (Camp ends Aug. 11):
Are you availible for an interview in Connecticut?
Yes No
If so, when?

 

Educational Information:

High School
Name of School:
Degree:
Year:
Major:
College
Name of School:
Degree:
Year:
Major:
 
Name of School:
Degree:
Year:
Major:

 

Professional References:
Name:
Phone Number:
Name:
Phone Number:

 

Camp Experience:
Camp Name:
Position:
Year:
Salary:
Director:
Phone Number:
 
Camp Name:
Position:
Year:
Salary:
Director:
Phone Number:
Professional Experience:
Company:
Year:
Position:
Employer:
Address:
Phone Number:
 
Company:
Year:
Position:
Employer:
Address:
Phone Number:

 

Other Information:
Varsity, Intra-murals, Clubs, Cultural, etc.
List all the activities that you can teach:
Have you ever been accused of or involved in an incident involving physical or sexual abuse of a child?
Yes No
If you answered yes, please explain:

 

 

  
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    • Kutsher's Sports Academy
    P.O. Box 252
    Great Barrington, MA 01230
    866-857-7678 413.644.0077
    marc@kutsherssportsacademy.com


    Official Supplier of KSA