Pony Express Council, Boy Scouts of America


General Information








Are you currently employed?


Emergency Contact



Scout Information

Are you currently registered with a Scout Unit?





   




Camping History

   








Previous Camp Staff Experience:



List all current certifications (for example: First Aid, CPR, Lifeguard, Welding, etc) and leadership positions applicable to camp:


Member of Mic-O-Say?

Mic-O-Say Awards:
    
    
    
    
    
    
    
    

References

You must list four.


Skills

Check the Program Area for which you have interest, check any merit badges earned, and list any additional skills you have pertaining to that area.













































































































































Staff Positions

Indicate your first and second choices of Staff positions and explain why you should be selected for those positions:






Is there anything else you would like to tell us about experiences, skills, volunteer activities, or other reasons you should be considered for a position on the Camp Geiger Staff?


Have You Ever Been Convicted of a Felony, Misdemeanor, or Are You on Probation in Missouri or Any Other State?


You May Answer "No" if Your Conviction Has Been Ordered Sealed, Expunged, or Eradicated. Conviction is Not an Automatic Bar to Employment. All Circumstances are Considered, Including the Specific Crime and When it Occurred.

Please Provide Complete Details Below:


Is There Anything Camp Geiger or the Pony Express Council Should Know That Makes You Unsuitable to Work With Children?


Please Provide Complete Details Below:


By clicking submit you affirm that, on your honor, the information on this Form is Correct