UBC O - Health Care Team - Application Form | BC Lions Society Easter Seals Camps

> UBC O - Health Care Team - Application Form

UBC O - Health Care Team - Application Form

This is the application form for any UBC Okanagan RN students wishing to do their practicum as a personal support worker at camp.

Contact Information

Applicant First Name: *

Last Name: *

Applicant Email: *

Suite Number:

Address: *

City: *

Province: *

Country: *

Postal Code: *

Primary Phone Number: *

eg: 6048731865

Secondary Phone Number:

eg: 6048731865

Sex: *

Female

Male

Age: *

19 or older

Chose date as of June 25, 2010

Application and Qualifications

Camp Questions

Please answer all questions

Please list all previous experience as a camp staff, volunteer or camper at any camp:

What do you think a "rickabamboo" is?: *

What do you think are 3 ideal qualities of a camp staff member?: *

Please list all other nursing related practicum’s/jobs up to this point: *

What would be your recipe for creating a community that embraces the beauty, diversity of self, others and the environment?: *

One of our objectives at camp is to give campers and staff the opportunity to challenge themselves, take risks and try new things in a safe, warm and supportive environment.

Please explain how you will ensure the campers you are working with meet this objective this summer: *

How will you meet this objective for yourself?: *

What do you expect your favourite part of this practicum will be? Your least favourite part?: *

Please rank the following terms in order of importance to you: *

	Motivation	Care	Ability to follow orders	Responsibility	Safety	Patience	Creativity	Sense of humour
1 (most important)
2
3
4
5
6
7
8 (least important)

only select one number per quality

Camp is the place where we share our knowledge and skills. Please indicate any areas where you have experience or feel comfortable running a workshop to peers in orientation:

	Experience	Workshop	Neither
Behaviour Support
Assisted Dressing
Assisted Eating
Personal Care
Advanced First Aid
Hearing Impairments
Lifts and Transfers
Seizures
Showering Assistance
Sign Language
Speech Therapy
Music Therapy
Drama Therapy
Adventure Therapy
Visual Impairment
Wheelchair etiquette

Medical Information

Do you have any health problems that could interfere with your ability to be at camp and work directly with campers?: *

yes

If you answered yes, please explain:

As you know, Camp is a wonderful place to grow and learn. Camp is also very emotional, physical and intense. You will work long hours and be required to do a wide range of tasks.

Are there any reasons you would have difficulty performing essential elements of the camp job you are applying for?:

At camp, we often put others needs before our own. How do you plan to take care of yourself this summer?: *

References

We will be checking your references. Please provide us with current contact information in the form of email AND phone number. We will also be checking with UBC O to determine suitability of this placement.

Reference 1

Reference First Name: *

Last Name: *

Company/Organization: *

Position: *

References relationship to you: *

Phone Number: *

eg: 6048731865

Email: *

Reference 2

First Name: *

Last Name: *

Company/Organization: *

Position:

References relationship to you: *

Phone Number: *

eg: 6048731865

Email: *

Alumni Reference

Do you know any past staff members from Easter Seals Camp (Shawnigan, Squamish, or Winfield) who can give a definite statement of your character?

First Name:

Last Name:

Email:

Additional Information

Have you ever been convicted of a criminal offence which has not been pardoned?: *

yes

If you answered yes, please explain:

Please copy and paste your resume below: *

Is there any additional information that you would like to share?:

I authorize investigation of all statements herein and release the camp and all others from liability in connection with this inquiry. I understand that, if employed, I will be an at will employee and that any agreement to the contrary must be in writing and signed by the coordinator of the camp. I also understand that untrue, misleading, or omitted information herein may result in dismissal, regardless of the time of discovery by the camp.

Thank you very much for taking your time and care in completing this form, due to large numbers of applications, only qualified applicants will be contacted.

Please review the above application before clicking the submit button. Submitting this form will serve as your acknowledgment that the above information is correct.

If this page does not go through, please e-mail us directly at camp@lionsbc.ca

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BC Lions Society
3981 Oak Street
Vancouver, BC, Canada, V6H 4H5
info@lionsbc.ca

Easter Seals Camps Staff
A resource to connect current staff with valuable information, schedules, etc...
Shawnigan | Squamish | Winfield

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UBC O - Health Care Team - Application Form