Form

PRINCETON-BLAIRSTOWN CENTER
158 MILLBROOK ROAD
BLAIRSTOWN, NEW JERSEY 07825
http://www.princeton.edu/princetonblairstown
Phone: (908) 362-6765
Fax: (908) 362-7699
EMPLOYMENT APPLICATION
Thank you for applying for employment with Princeton-Blairstown Center. A complete application must also include two e-mails of reference (see below).
Today's date:
/ Month / Day Year
PRESENT ADDRESS
Full Name
First Name Last Name
Present Address:
City:
State/Province:
Zip/Postal Code:
E-mail
Home Phone Number
- Area Code Phone Number
Cell Phone Number
- Area Code Phone Number
Date Address Expires:
/ Month / Day Year
PERMANENT ADDRESS
Permanent Address:
City:
State/Province:
Zip/Postal Code:
Are you at least 19 years old?

Yes No
Are you legally allowed to work in the USA?

Yes No
Position Applied for:
What is your availability?

Spring Summer Fall Winter
How did you hear about us?
EDUCATION
Type of School:
Name of School:
Number of Years Completed:
Graduation Date:
/ Month / Day Year
Major or Degree:
Use this additional section in case you have more than one Major or Degree
Type of School:
Name of School:
Number of Years Completed:
Graduation Date:
/ Month / Day Year
Major or Degree:
Criminal, traffic or court record
Have you ever been convicted of a misdemeanor, felony or federal offense?

Yes No
If yes, please explain:
Do you have a driver's license?

Yes No
State of issue:
Driver's License #:
EMPLOYMENT INFORMATION
Please list the last three employers in order, most recent first. Please note: We will contact two of the people on this list. Each section must either be filled in or an explanation provided.
1.
Name of Most Recent Employer:
Name of Last Supervisor:
Dates of Employment:
From:
/ Month / Day Year
To:
/ Month / Day Year
Complete Address:
Phone Number
- Area Code Phone Number
Supervisor E-mail
Last Job Title:
Reason for Leaving (be specific):
May we contact this employer?

Yes No
List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:
2.
Name of Employer:
Name of Last Supervisor:
Dates of Employment:
From:
/ Month / Day Year
To:
/ Month / Day Year
Complete Address:
Phone Number
- Area Code Phone Number
Supervisor E-mail
Last Job Title:
Reason for Leaving (be specific):
May we contact this Employer?

Yes No
List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:
3.
Name of Employer:
Name of Last Supervisor:
Dates of Employment:
From:
/ Month / Day Year
To:
/ Month / Day Year
Complete Address:
Phone Number
- Area Code Phone Number
Supervisor E-mail
Last Job Title:
Reason for Leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements, or promotions while you worked at this company:
May we contact this Employer?

Yes No
PHYSICAL REQUIREMENTS
Princeton-Blairstown Center program staff must be able to work in the outdoors in a remote place during all seasons, lift and carry up to 35 pounds, and work in high places such as in ropes courses and in trees.
Are you able to fulfill these physical requirements?

Yes No
If unable to fulfill physical requirements, please explain:
REFERENCES
Please list two people who are not related to you and who are not named in the "employment" section above, who can comment on your education, work and life experiences. Please ask your references to submit the form online by going to the bottom of the following page on our website at www.princeton.edu/princetonblairstown/employment
Name of Reference #1:
Address:
E-mail
Phone Number
- Area Code Phone Number
Relationship:
Name of Reference #2
Address
E-mail
Phone Number
- Area Code Phone Number
Relationship:
SPECIAL QUALIFICATIONS
1. Describe any work or volunteer experience with adolescents, urban youth, or adjudicated youth:
2. Describe any wilderness training or experience (such as Outward Bound or NOLS), or relevant life experiences. Include any experience belaying, rappelling, rock climbing and backpacking:
3. Describe any experience you have with team-building, service learning, problem-solving initiatives, or group games/initiatives:
Describe your experience facilitating low and high ropes courses ( how many months/years, what populations you have facilitated, etc).
4. What languages other than English do you speak?
5. Use this space to add additional information describing your full qualifications for this position:
PERSONAL INFORMATION
1. What interests you about working with youth in an adventure-based program?
2. What do you think is the greatest problem facing youth today?
3. What strengths would you bring to Princeton-Blairstown Center if hired?
4. Describe any counseling or teaching skills you possess:
5. What does self-awareness mean to you and how do you use it?
6. To help us get to know you better, is there anything else that qualifies you for this job that you would like to share with us?
Princeton-Blairstown Center's Policy on Smoking, Drugs and Alcohol
SMOKING : Staff are not permitted to smoke while on duty or at any time while on Center property. One warning will be given for infractions. Repeated infractions will result in disciplinary action.

DRUGS : The possession or use of any illegal drugs on Center property or at any time while employed by Princeton-Blairstown Center will be grounds for immediate termination of employment.

ALCOHOL : Possession and/or use of alcoholic beverages while on duty in leadership or support capacity is prohibited. Staff members are expected to return to the Center after time off in a "ready to work" condition. "Ready to work" is defined as neither being under the influence of alcohol nor experiencing the effects of alcohol consumption. The Co-Directors and/or their designee reserve the right to determine "ready to work" status.

The Princeton-Blairstown Center maintains an alcohol free environment during the summer season. Alcohol free means that staff may not consume, supply, encourage or condone the use of alcohol during the summer season on Center property. Violation of this policy WILL lead to disciplinary action up to and including termination.
Can you commit to Smoking/Drugs and Alcohol Policy?

Yes No
CERTIFICATIONS
Please list and describe all relevant certifications and licenses.
**CPR - Type
Expiration Date:
/ Month / Day Year
**First-Aid - Type
Expiration Date:
/ Month / Day Year
Lifeguard/ALS - Type
Expiration Date:
/ Month / Day Year
Other Certifications (teacher, social worker, WSI, etc.
Expiration Date:
/ Month / Day Year
**NOTE: CURRENT certifications in Standard First Aid and CPR are REQUIRED prior to your first day of employment.
To be read and signed by the applicant
This certifies that I completed this application, and that all entries on it and information in it are true and complete to the best of my knowledge.

I authorize you to make such investigations and inquiries into my past employment, educational credentials, or other employee-related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools or any other persons from all liability in responding to inquiries in connection with this application.

In the event of being an employee of Princeton-Blairstown Center, I understand that false or misleading information given in this application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of Princeton-Blairstown Center as permitted by law.
Full Name
First Name Last Name
Today's Date
/ Month / Day Year
If you would like a copy of your application, please print it out before clicking the "submit" button below.
Should be Empty:

PRINCETON-BLAIRSTOWN CENTER

EMPLOYMENT APPLICATION

PRESENT ADDRESS

PERMANENT ADDRESS

EDUCATION

Criminal, traffic or court record

EMPLOYMENT INFORMATION

PHYSICAL REQUIREMENTS

REFERENCES

SPECIAL QUALIFICATIONS

PERSONAL INFORMATION

Princeton-Blairstown Center's Policy on Smoking, Drugs and Alcohol

CERTIFICATIONS

To be read and signed by the applicant