Merrick Woods Country Day School and Summer Fun


Name		Email


Date of Birth		Age as of July 1


Home Address


Town		State


Zip		Phone


Social Security Number		Do you have working papers?
		Yes No

Present School		School term as of September 1


Name, age & sex of any children who will be attending our summer program

Please check the activities you can lead:


What activities do you feel best at?


Do you play an instrument?		Which one?
Yes No

Can you read music?		Can you teach?
Yes No		Yes No

Age group preferred:


Minimum salary you would consider:
for summer season

Have you ever been convicted of a felony (we will check)?
No Yes If yes, explain:

Have you ever been charged with a crime involving children?
No Yes

Please be aware that Merrick Woods does a criminal background check on all employees over the age of 18. Staff members are also subject to pre-employment and random drug testing.


Do you drive?
No Yes

Would you drive a Merrick Woods owned mini-bus?
No Yes

Do you need transportation?
No Yes


Please write anything you feel might encourage a favorable consideration of your application:

Immediate Questions? Feel free to send an email: