We appreciate the time you are taking to fill in this form

Program(s) Applying for:

12 month visa program (Australia and New Zealand Only) Summer Camp Summer Resort Winter Resort


Please complete ALL pages of the application and Addendums

CV Attachment
CV:
Personal Information
Please attach a smiling passport size photo        
Gender:         
* Family Name:
* First Name
Middle Name
Date of birth: (mm/dd/yy)
City of Birth:
Country of Birth:
Citizen of:       
*Permanent Resident of:      
Do you have a valid American Passport?      
Dual Citizenship/passports?        
If YES what Passport will you be using:
  
Passport Issue Place: 
Passport number:
  
 Passport Issue Date
Expiry Date::
Present Occupation/Level in University?  University/Employer:  
         
Postal Address:   
  
Mailing Address:(fill in if Diferent then Postal address)
Address:    Address: 
City:    City: 
Province/State:    Province/State: 
Postal/Zip Code:    Postal/Zip Code:
Contact Information :   
      
* Phone:      
Other phone:       
Fax:      
* Email Address 1:        
Email Address 2:        
         
Marital status:      
Number of children:       
Drivers License:
License# :
         
Emergency Contact Information :   
Emergency Contact Name:

Relationship:
Emergency Contact Cellular Number:
Alternate Number:
         
US Contact Information :   
Do you have friends/relatives in the US?      

Name  

    

Relationship:

    

Location:

      

Contact Cellular Number:

      

Alternate Number:

      

 

        

Work Visa Information

Have you ever been to the US?  On what type of Visa?
Have you ever been on a J1 visa to the USA      
If yes what years: to
Name of Program and sponsoring company:      
Do you currently have a tourist visa (B1-B2) to the USA:    
If Yes: What is the Validation Date:    
Have you ever been refused/cancelled an American visa:    
If yes, please explain:  
         
Background Check
Have you ever been arrested or convicted of a criminal offence or are you at present, the subject of a criminal investigation?
If yes, please explain  
Have you ever been charged or convicted of sexual abuse or molestation?
If yes, please explain  
NOTE: Some programs, employers and consulates may require a criminal check from the Police Department.
     

Education and Military Service

List Secondary/High Schools Attended:
Dates Attended
 
Dates Attended
Completed?
List College/University attended
Dates Attended
 
Dates Attended
 
Graduation Date:
Major course of study:  
Career Plans:    
Home language:  
Languages spoken fluently:    
If English is not your first language, for how long have you been studying it?  
Level of your English:    
Do you have any First Aid/ lifeguard/ other training/ Certifications?
If yes, please add scanned certificate.
Have you ever done Military Service?  
If YES which Branch? Rank:
Date of Enlistment :
       
Work History
Company Name:
Position
Address
Telephone
Dates Worked
Reason for leaving
1


to
2

to
3

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4

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Health Statement
This information is not pat of the acceptance process. It will only be used to ensured proper care and ensure a healthy and safe summer

(PLEASE CIRCLE)      
Are you in good health? (Asthma/Migraines etc)? If no explain
Do you have any Physical Disabilities? If yes explain
Do you have any allergies If yes explain
Do you take any medication? If yes explain
Have you ever been treated for
any mental disorders, including
psychiatric care, depression,
eating disorders, drug addiction
or any other emotional disorders?		 If yes explain
Do you require any special diet? If yes explain
Do you smoke? If yes explain
If yes to above, are you willing to work in a non smoking environment?    
Do you consume Alcoholic beverages? If yes How often
     
About You
Do you have any visible tattoos/ piercing? If yes explain    
If yes to above are you willing to cover/remove visible
tattoos/piercing during work?
Do you have any religious restrictions? If yes explain    
List your interests, hobbies or activities:
What are your strongest qualities:        
Do you prefer to work alone or in a group? Why?    
Why do you want to participate in this program?        
What will be your biggest challenge on this program?
Why should an employer hire you?        
Have you ever worked with children:
Age Group:        
Position:

 
Recommendations & Certificates
Recommendations:
 
 
Certificates:
 
 

 

 

I understand that I will be placed in a position that will require my presence for a minimum of 12 weeks (Summer Work Travel) and 9 weeks (Summer Camp) and that time off is determined by the Employer relative to the position assigned. I understand that I will receive a full job description and will be paid a stipend or hourly wage dependant on the position and equal to others in the same position. I understand that housing may or may not be provided and if it is provided it will offer minimal privacy. In addition, I understand that my success in this position depends upon my willingness to participate in activities and work outside my specific job description.

 


I Agree