Returning Staff Application COMPLETE THIS FORM IF YOU HAVE PREVIOUSLY WORKED AS STAFF AT THE MILL IN 2016 OR 2017 Learn more about the available positions for 2018 by clicking here Personal Information Which position are you applying for?:---Program DirectorProgram CoordinatorProgram AssistantHead ChefSous ChefKitchen AssistantHealth Care Assistant -First AiderFemale Cabin LeaderMale Cabin LeaderCamp Life LiaisonLeadership Development Coordinator What would be your second choice for a position?: ---Program CoordinatorProgram AssistantHead ChefSous ChefKitchen AssistantHealth Care Assistant -First AiderFemale Cabin LeaderMale Cabin LeaderCamp Life LiaisonTREK:Leadership Development Coordinator What would be your third choice for a position?: ---Program CoordinatorProgram AssistantHead ChefSous ChefKitchen AssistantHealth Care Assistant -First AiderFemale Cabin LeaderMale Cabin LeaderCamp Life LiaisonTREK:Leadership Development Coordinator First Name: Last Name: Birthday: Gender: Current Address: City: Province: ---AlbertaBritish ColumbiaOntarioQuebecNova ScotiaNew BrunswickManitobaPrince Edward IslandSaskatchewanNewfoundland and Labrador Postal Code: Phone Number: Alternate Number: E-Mail: Social Insurance Number: Emergency Contact Information Contact Name: Relationship to self: Phone Number: Alt Number: Medical Information Health Care Number: Providing Province: ---AlbertaBritish ColumbiaOntarioQuebecNova ScotiaNew BrunswickManitobaPrince Edward IslandSaskatchewanNewfoundland and Labrador Medically Diagnosed Allergies Foods (specify): Drugs (specify): Other (i.e. Bee Stings): My camper carries an Epipen: No Yes for the following allergy: Food Restrictions/Intolerances (if applicable) Note: All dietary constrictions must be listed here prior to the start of the session. All special dietary needs will be shared with the kitchen staff. Please note Mill Creek Camp menus DO NOT cater to likes/dislikes. We have a balanced and varied menu that does include red meat, poultry and fish. Select all that apply: Vegetarian (no meat) Vegan (no meat/byproducts) Celiac Disease Lactose Intolerant Medications Is your camper bringing medications to camp? No Yes Please list ALL medications being sent to camp. Medications MUST be in original packaging. (Medication Name/Dosage/Administration Time/Reason for Taking) Please answer the following questions: Tetanus Immunization Date -must be current (Mandatory): Are there any immunizations that you have chosen NOT to give your camper?: Please indicate any significant medical conditions, physical limitations, or other concerns which will help us effectively care for your camper: Anaphylactic Allergy Asthma Bed Wetting Concussions/Head Injuries Diabetes Ear/Nose/Throat Infection Epilepsy Migraine Headaches Recent Illness/Injury Mental Health Concerns If any of the above were selected, please explain: To the best of my knowledge, the information on this medical record is complete, current, and accurate: No Yes To the best of my knowledge, I do not have a communicable disease, and am physically able to participate in all Camp activities except as indicated above. No Yes All medical problems or conditions requiring ongoing medical supervision or care have been fully noted. I give permission for this health information to be shared with the appropriate Camp staff and outside Medical Personnel as necessary. I understand that I will be notified if extended care has been provided by the Camp Health Staff, or following assessment or treatment by a local physician.In the case of an emergency, if I cannot be reached, permission is hereby given to the Camp staff to take whatever steps deemed necessary to ensure the safety and health of myself. This also allows permission for the Camp to contact my family physician/specialist. (Please inform your physician/specialist that you have given this authorization.)No Yes I agree to notify the Camp in writing if any changes occur in my health status, medications, or family status between now and the start of the Camp session. No Yes Other Information T-Shirt Size: X-smallSmallMediumLargeX-LargeXX-Large Drivers License?Yes, Class 5Yes, Class 1-4No Have you ever been convicted of a criminal offence or are there current charges before the court?YesNo If yes, please explain: Do you have current training in First-Aid and CPR?Yes, Level C or betterNo Do you have any physical limitations or disabilities which may affect working at camp?YesNo If yes, please explain: Tell Us About Yourself Why do you want to return to the staff team at Mill Creek Camp? Why are you the best fit for this position? Which position are you least suited for? Why? Reflecting on your most recent work experience at Mill Creek Camp, was it a positive or negative experience? Why? Describe your interaction with your faith over the past year: How has camp positively impacted your life? What would be the best "theme" in your opinion? What woudl be the worst "theme" in your opinion?