Fields marked with an * are required Personal Information * First Name * Last Name * Phone * Email * Street Address * City * State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC * Zip Your emergency contact's information: * First Name * Last Name * Phone * Relationship to You * Street Address * City * State - Select State - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington DC ARMED FORCES AFRICA \ CANADA \ EUROPE \ MIDDLE EAST ARMED FORCES AMERICA (EXCEPT CANADA) ARMED FORCES PACIFIC * Zip Education * Please indicate the highest level of education you have achieved so far: -- None -- 1 Year of High School 2 Years of High School 3 Years of High School High School Diploma Some College Associates Degree Bachelors Degree Masters Degree Doctorate (PhD or equilvalent) Degree * High school you attended or are attending: If applicable, college you attended or are attending: If applicable, your college major or majors: Experience Please list any work or volunteer experience with any individuals with special needs or in the area of recreation. Include: place worked, length of time, age and type of disability of participants, supervisor’s name and phone number. Volunteering Interests and Skills * Why do you want to work at NEDSRA? * Please indicate any 3 hour segments (beginning time noted) that you would be available to work: Monday Morning 9:00am Monday Afternoon 12:00pm Monday Evening 6:00pm Tuesday Morning 9:00am Tuesday Afternoon 12:00pm Tuesday Evening 6:00pm Wednesday Morning 9:00am Wednesday Afternoon 12:00pm Wednesday Evening 6:00pm Thursday Morning 9:00am Thursday Afternoon 12:00pm Thursday Evening 6:00pm Friday Morning 9:00am Friday Afternoon 12:00pm Friday Evening 6:00pm Saturday Morning 9:00am Saturday Afternoon 12:00pm Saturday Evening 6:00pm Sunday Morning 9:00am Sunday Afternoon 12:00pm Sunday Evening 6:00pm * Please indicate any types of classes/areas you would like to assist with: Team Sports Social Clubs Arts & Crafts Swimming Nature Programs After-school Programs Preschool Programs General Programs for All We provide types of programs to meet the need of differently abled people. Please indicate if you prefer to work in one or more of the following program areas: Intellectual Disability or Autism Physical Disability or Visual Impairment Adaptive Sports Special Olympics Please indicate which age groups you prefer to work with: Youth Adult If you have valid/current certifications or licenses in these areas, please indicate: Water Safety Instructor Certification Personal Training Certification CPR Certification Lifesaving Certification Language Interpreting Skills Adaptive Aquatics Certification Commercial Drivers License First Aid Certification Other Certifications If you speak other languages (besides English), please indicate which ones here: Spanish Polish ASL Russian Hindi / Urdu Mandarin Arabic Bengali Japanese French (Canadian) German Other * How did you hear about NEDSRA? None Referral from Friend Ad on Web Ad on TV or Radio Facebook Twitter Searched online (Google) Disclaimer * I am over 16 years of age. I hereby assume complete responsibility for any injury or damage sustained by the applicant and release Northeast DuPage Special Recreation Association of any and all liability for such injury or damage occurring during employment for Northeast DuPage Special Recreation Association. If you are a human seeing this field, please leave it empty.
Every day when I picked our son up from summer camp, he was always HAPPY. It has made our summer AMAZING! – Anonymous
