Employee Information & Documentation

"*" indicates required fields

Employee General Information

Before starting this form, please have on hand your:

* Driver's license
* Social security card
* Immunization record
* Emergency contact info
* Physician info
* Health insurance card
* Vehicle information (for parking sticker)
* Bank account information (for paycheck direct deposit)

You may upload documents through campsweeney.org/upload
or email a copy to: hr2@campsweeney.org

Please make sure you have at least 30 minutes to complete this form since you will not be able to save your work if you have to stop before submitting.

Employee Name

First Last

Full Legal Name (such as Susan A. Smith or Jonathan H. Jones, Jr.)*

Name preferred to be called*

Usually your first name, middle name, or some variation.

Department*

Counseling Staff

Medical Staff

Program Assistant (PA) Staff

Kitchen Staff

Office Staff

Maintenance/Facility Staff

AV Staff

Legacy Staff

Other

Have you worked for Camp Sweeney before?*

Yes, I worked last year.

Yes, but I did not work last year.

No, I have never worked for Camp Sweeney.

Social Security Number*

Upload a copy of your social security card safely and securely at campsweeney.org/upload or email a copy to: hr2@campsweeney.org

Sex*

Male

Female

Date of Birth*

Marital Status*

Single

Married

Are you a US Citizen?*

Yes

Permanent Address*

Where you will receive your W2 in January next year.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Is the permanent address where you want your mail (contracts, notices, etc.) sent this spring (Jan-May)?*

Yes - send to my permanent address above

No - send to my spring address (school/university)

Spring Address*

This address is where you will receive your mail from now until summer.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Do you have a driver license?*

Yes

State where Driver License was issued*

Driver License Number*

Upload a copy of your driver license safely and securely at campsweeney.org/upload or email a copy to: hr2@campsweeney.org

Driver License ISSUE Date*

Driver License EXPIRATION Date*

An alternate ID can be:
* a U.S. Passport
* a photo ID card issued by federal, state or local government
* a school ID with photograph
* a Voter's Registration Card
* a US Military Card or Military dependent's ID card

Upload a copy of your alternate form of Photo ID safely and securely at campsweeney.org/upload or email a copy to: hr@campsweeney.org

Tee Shirt Size*

Adult Small

Adult Medium

Adult Large

Adult X-Large

Adult XX-Large

Adult XXX-Large

Emergency Contacts

Primary Contact Name*

Primary Contact Phone*

Primary Contact Relationship*

Secondary Contact Name*

Secondary Contact Phone*

Secondary Contact Relationship*

General Health Information

Recent hospitalizations or illnesses

Chronic Disorders

Medications

Medical/physical restrictions or limitations

Drug Allergies

Food or Other Allergies

Personal Physician*

Physician Phone*

Do you have health insurance?*

Yes

Upload a copy of the front and back sides of your insurance card(s) safely and securely at campsweeney.org/upload or email a copy to: hr2@campsweeney.org

Immunizations and Physical Exam

Current vaccinations and a physical exam are a requirement to work at Camp Sweeney. Vaccinations include:
Diptheria-Tetanus (Td), within last 10 years
MMR
Hep B, Doses 1, 2, and 3
Hep A, Doses 1 and 2
Meningococcal meningitis (MCV4 or MPSV4) (11 to 22 years old)
Oral Polio
COVID-19

Have you had a physical exam within the last 2 years?*

Yes

DATE of Physical Exam (MM/YYYY)*

A current physical exam is REQUIRED to work at Camp Sweeney. Please get a physical exam as soon as possible and forward the date to the camp office.

Have you had your Diptheria-Tetanus Vaccine (Td) within the last 10 years?*

Yes

DATE of Diptheria-Tetanus Vaccine (MM/YYYY)*

A current tetanus booster is REQUIRED to work at Camp Sweeney. Please get your tetanus booster as soon as possible and forward the date to the camp office.

Have you had an Measles, Mumps, Rubella (MMR) Vaccination?*

Yes

No - I had the Measles or the Mumps

DATE of MMR Vaccine (MM/YYYY)*

DATE you had the Measles or the Mumps (MM/YYYY)*

An MMR (Measles, Mumps, Rubella) vaccination is REQUIRED to work at Camp Sweeney. Please get your vaccine as soon as possible and forward the date to the camp office.

Have you had all three doses of your Hep B vaccine?*

Yes - I have had all three doses

No - I have only had one dose

No - I have only had dose 1 and 2

No - I have not had any.

DATE of Hepatitus B Vaccine, Dose 1 (MM/YYYY)*

DATE of Hepatitus B Vaccine, Dose 2 (MM/YYYY)*

DATE of Hepatitus B Vaccine, Dose 3 (MM/YYYY)*

Hepatitus B vaccination is REQUIRED to work at Camp Sweeney. Please complete your vaccine as soon as possible and forward the date(s) to the camp office.

Have you had 2 doses of your Hepatitus A vaccine?*

Yes - I have had 2 doses

No - I have only had one dose

No - I have not had any.

DATE of Hepatitus A Vaccine, Dose 1 (MM/YYYY)*

DATE of Hepatitus A Vaccine, Dose 2 (MM/YYYY)*

Hepatitus A vaccination is REQUIRED to work at Camp Sweeney. Please complete your vaccine as soon as possible and forward the date(s) to the camp office.

Have you had a meningococcal meningitis (MCV4 or MPSV4) vaccine?*

Yes

DATE Meningitis Vaccine (MM/YYYY)*

A meningococcal meningitis vaccination is REQUIRED to work at Camp Sweeney. Please get your vaccine as soon as possible and forward the date to the camp office.

Have you had an Oral Polio Vaccination?*

Yes

DATE Oral Polio Vaccine (MM/YYYY)*

An oral Polio vaccination is NOT REQUIRED to work at Camp Sweeney, but it is strongly RECOMMENDED. If you get your polio vaccine, please forward the date to the camp office as soon as possible.

Have you had a Varicella (chickenpox) Vaccination?*

Yes

No - I had the chickenpox

DATE Varicella Vaccine (MM/YYYY)*

DATE you had the chickenpox (MM/YYYY)*

A varicella vaccination is NOT REQUIRED to work at Camp Sweeney, but it is strongly RECOMMENDED. If you get your varicella vaccine, please forward the date to the camp office as soon as possible.

COVID-19: Have you been diagnosed with COVID-19?*

Yes

DATE you were diagnosed with COVID-19 (MM/YYYY)*

COVID-19: Have you been vaccinated for COVID-19?*

Yes

DATE of latest COVID-19 vaccine booster (MM/YYYY)

Voluntary Disclosure Statement

Have you ever been arrested or convicted of ANY crime, including sex related or child abuse offenses?*

Yes

Details of offenses

Vehicle Information

Do you have a vehicle that you will be driving to camp?*

Employee vehicles are required to be identified by a parking sticker.

Yes, I will have a vehicle parked on campgrounds.

No, I will not have a vehicle parked on campgrounds.

Vehicle Year*

Vehicle Make/Brand*

Vehicle Model*

Vehicle Color*

Vehicle License Plate*

Direct Deposit Authorization

Would you like to have your paycheck and reimbursements deposited directly into your bank account? This is a free service.*

Yes

If you worked last year AND used direct deposit, is your bank information the same?*

Yes, my bank information is the same.

No, my bank information is not the same.

I am not sure if my information is the same.

N/A I did not work last year or I didn't use direct deposit last year.

You indicated you have never worked at Camp Sweeney before. If so, we do NOT have your bank info on file. Please change previous answer to "N/A I did not work last year" so you will be able to enter your bank information.

Bank Name*

Bank Account Type*

Checking Account

Savings Account

Bank City and State*

Bank Account Number*

Your bank account number is NOT the same as the 16-digit number on your debit card.

Bank Routing Number (9-digits)*

Certifications, Authorizations, and Permissions

Date