SuperCamp   SuperCamp




QLN Returning Staff Application
ROLE(S) DESIRED
Team Leader (i.e. camp counselor) Site Administrator Wellness
Senior Team Leader Office Manager Products Coordinator
Facilitator (i.e. school/professional) Logistics Manager Counselor

GENERAL INFORMATION
First Name:*  
Last Name: *  
Familiar Name:
Primary Address
Address: *  
Address Line 2:
City: *  
State:
Zip Code: *  
Country:
Home Phone (including area code): *     
Cell Phone (including area code):  
Work Phone (including area code):  
Fax (including area code):  
EMail:  
Other Address
Address:
Address Line 2:
City:
State:
Zip Code:
Country:
Years worked with QLN:
Present Occupation:
If educator, grades taught:
If educator, subjects taught:
If in college or faculty, name of school:
Projected graduation date (MM/YYYY):
If in college, major:
What languages do you speak fluently?
 
REQUIRED INFORMATION
The following information is required either by local, state or federal authorites or due to insurance requirements that
QLN staff must be able to meet.
Are you a U.S. Citizen?*     
If no, are you authorized to work in the U.S.? 
If from country other than the United States, you must attain a working visa from your country. You are responsible for all
costs associated with this process. Please call us for more information.
Do you have a valid drivers license?*      
License Number:   State:  Exp:   (MM/DD/YYYY)  
 
Have you been cited for any moving violations in the last 3-5 years?*    
  If yes, please explain:
 
Have you been convicted of a felony or misdemeanor within the past 5 years?*     
  If yes, please explain:
 
Please indicate your shirt size*:    
Wellness applicants please submit a copy of first aid - CPR certification or license.

NOTES
  • QLN may obtain a copy of your DMV record.
  • You will not be denied employment solely because of a conviction record, unless the offense is related to the
    position for which you are applying.

AVAILABLE DATES *

All employee placements are made with the best interest of QLN as the top priority.
Please enter the dates you are available to work.
Available Start Date
<June 2008>
SunMonTueWedThuFriSat
25262728293031
1234567
891011121314
15161718192021
22232425262728
293012345
 End Date
<September 2008>
SunMonTueWedThuFriSat
31123456
78910111213
14151617181920
21222324252627
2829301234
567891011

ADDITIONAL INFORMATION (250 characters maximum for each answer)
Please write a current third person, professional bio (education, experience, awards)
 
What professional growth experiences have you had this year?
 
Why do you want to work this position this summer?
 
 

FACILITATORS / LEAD FACILITATORS ONLY
Please choose the best response for each curriculum area.

Junior Forum Reading/State Management
Junior Forum Writing/Smart Stations
Junior Forum Quantum Strategies/Math Mastery
Senior Forum Reading/Math Mastery
Senior Forum Writing/Creativity
Senior Forum Quantum Strategies/SAT
Youth Forum Reading
Youth Forum Writing
Youth Forum Quantum Strategies


AGREEMENT
This Agreement shall be governed in accordance with the laws of the State of California. In the event of any dispute arising under or involving any provision of this Agreement, you and QLN agree to submit any such dispute to a neutral binding arbitrator within one year of the date the dispute first rose. In the event of any action is necessary to enforce the terms of this Agreement, the prevailing party shall be entitled to recover reasonable costs and attorneys fees, whether or not any suit is filed. I also acknowledge that if employed by QLN, I will have the right to terminate my employment at any time, with or without cause or advance notice. This at-will employment relationship shall remain in effect throughout my employment by QLN and may not be modified by any oral or implied agreement. Furthermore, the at-will nature of my employment may not be modified or abrogated by any oral or written statement(s), including performance evaluations, the granting of salary increases, bonuses, or promotions, or by the length of my employment.


AUTHORIZATION
I certify that the information contained in this application is true and complete to the best of my knowledge. I understand that if employed, falsified statements on this application shall be grounds for dismissal. I understand that QLN programs are a full time non-smoking and drug free environment.