PRINCETON-BLAIRSTOWN CENTER
158 MILLBROOK ROAD
BLAIRSTOWN, NEW JERSEY 07825
http://web.princeton.edu/sites/pbcenter
Phone: (908) 362-6765
Fax: (908) 362-7699
EMPLOYMENT APPLICATION
Thank you for applying for employment with the Princeton-Blairstown Center. Please type or print all answers in ink. A complete application must also include two letters of reference (see below).
Today's date:
PRESENT ADDRESS
Name:
Present Address:
City:
State/Province:
Zip/Postal Code:
E-Mail Address:
Home Phone:
Cell Phone:
Date Address Expires:
PERMANENT ADDRESS
Permanent Address:
City:
State/Province:
Zip/Postal Code:
Home Phone:
Cell Phone:
Social Security Number:
Are you at least 19 years old?	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:
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:
Major or Degree:
Have you ever been convicted of a misdemeanor, felony or federal ofense?	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:
To:
Complete Address:
Phone #:
E-Mail Address:
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 your employer?	Yes No
2.
Name of Employer:
Name of Last Supervisor:
Dates of Employment:
From:
To:
Complete Address:
Phone #:
E-Mail Address:
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 your Employer?	Yes No
3.
Name of Employer:
Name of Last Supervisor:
Dates of Employment:
From:
To:
Complete Address:
Phone #:
E-Mail Address:
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 your 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 no, please explain:
REFERENCES
Please request to your references to submit the reference form by going to our REFERENCES link provided here.
Name of Reference #1:
Address:
E-Mail Address:
Telephone:
Relationship:
Name of Reference #2:
Address:
E-Mail Address:
Telephone:
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 or awards. 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:
4. What languages other than English do you speak?
5. Use this space to add any additional information necessary to describe your full qualifications for the position which you are applying:
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 the Princeton-Blairstown Center if hired?
4. Describe any counseling or teaching skills you possess:
5. 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?
THE 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 actions.
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 Program Coordinators and/or their designee reserve the right to determine "ready to work" status. Staff who are not of legal drinking age will not be permitted to drink on Center property at any time. Only one warning will be given for infractions, a second incidence will result in termination of employment.
Can commit to Smoking/Drugs and Alcohol Policy	Yes No
CERTIFICATIONS AND LICENSES
**CPR - Type
Expiration Date
**FIRST AID - Type
Expiration Date
LIFEGUARD / ALS - Type
Expiration Date
**NOTE: CURRENT CERTIFICATION in Standard First Aid and CPR are required prior to your first day of employment. Inquire about whether these certifications will be included in your training.
TO BE READ AND SIGNED BY APPLICANT
By submitting this application I certify 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, and other employee-related matters as may be necessary in arriving at an employment decision. I hereby release employers, schools or persons from all liability in responding to inquiries in connection with this application.
In the event of being an employee of the 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 the Princeton-Blairstown Center, as permitted by law.
Applicant's name:
Today's date: