Senior Intern Application Form Senior Intern Application Form Returning Intern Application FormStep 1 of 250%Name* First Last Email* Permanent AddressAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneCellAre you legally authorized to work in the United States?* Yes NoCamp 2016 DatesStaff & Senior Interns*: Sunday, June 19 - Sunday, August 21, 2016*If you are unable to participate for the full nine-week internship, you may be able to complete a four-week internship. First Session Internship: June 25-July 23, 2016 Second Session Internship: July 23-Aug. 20, 2016. Please indicate your need for this below.Please also list any date conflicts you may have for this summer. Any conflicts may prevent employment, and must be discussed and approved before you can be rehired.Date Conflicts:Additional Education and ExperiencePlease describe any additional education and related work experience you will have by this summer that was not listed on your Internship application from last summer.Additional Education and Experience Details:Camp PositionPlease describe the position for which you are most interested in interviewing. Please note that some positions will not be available. Use the checklist to mark all positions in which you may be interested.Position Details:Counselor PositionsBunk Counselor: South North Coop HillRelief Counselor: Camping & Campfires Special Events Sunshine & Staff MoraleInstructor and Camp Life PositionsPlease use the checklist below to mark any programs in which you can teach (1) or assist (2).MusicPiano:Voice:Strings:Winds & Woodwinds:Brass:Guitar:Percussion:Recording Arts:Theater Performance and Technical TheaterActing:Directing:Set Design:Costume Design:Lighting Design:Sound Design:DanceBallet:Jazz/Modern:Hip Hop:Yoga:Please list any other dance specialties:Visual Arts, Green Corps and Creative WritingPainting:Drawing:Sculpture:Ceramics:Fiber Arts & Crafts:Printmaking & Multimedia:Green Corps:Creative Writing:Journalism:Photography and VideoPhotography:Documentarian:Video:Horseback Riding, Sports and SwimHorseback Riding:Soccer:Tennis:Swimming Instructor & Lifeguard:Certifications: Current Swimming Instructor Certification and Lifeguard Certification Will Be Certified Before CampLifeguard:(Full-time, or part-time positions available for instructors in other departments.)Certifications: Current Lifeguard Certification Will Be Certified Before CampPlease list any other group sports:Camp LifeOffice Coordinator:(Phones, e-mail, mail, camp store, finances, etc.)Purchaser:(Purchase and distribute supplies, reporting and accounting, etc.)Driver's License: Licensed to Drive in New Jersey (company vehicle provided)Gardener:(Full time, or part-time positions available for instructors in other departments)Camp Nurse:(2, 4, 6, or 8-week positions available, camperships for children age 9-17)Nursing Credentials: RN LPNLaundry Staff:QuestionsPlease describe anything new — workshops, minors, special events, rituals, fireside chats — you hope to bring to Appel Farm Camp.New Ideas Details:Please explain below why you would like to be hired as a Senior Intern this summer.Application Essay Answer:*Application Essay AnswerCriminal History StatusHas there been a change to your criminal history status since you last applied to work at The Appel Farm Arts and Music Center, Inc.? Yes NoIf yes, please explain.APPLICANT RELEASE AND AUTHORIZATION for BACKGROUND CHECK: * The above information is true to the best of my knowledge.By submitting this application, I hereby authorize The Appel Farm Arts and Music Center, Inc. or authorized representatives of the company bearing this application to obtain and release any information pertaining to my background, for employment or volunteer purposes. I hereby fully release and discharge my prospective employer or other source providing information from all claims and damages arising out of or relating to any investigation of my background for said purposes.The Appel Farm Arts and Music Center, Inc. is an equal opportunity employer and hires without discrimination based on race, creed, color, national origin, nationality, ancestry, age, sex, sexual orientation, marital status, atypical cellular or blood trait, liability for service in the armed forces in the United States, or mental or physical disability subject only to conditions and limitations applicable alike to all persons.CaptchaΔ