Counselor Application

Address

Phone Number
Area CodePhone Number
E-mail
Do you check your email daily?
YesNo
Grade Entering next year 2022/2023
School/College next year 2022/2023
List dates you're available this summer
Are you CPR certified?
YesNo
Have you ever had a school suspension or expulsion? If so please provide history and details.
Have you ever had a delinquency adjudication? If so please provide history and details.
Have you ever been convicted of an assault or other offense? If so please provide history and details.
Returning counselors need not fill out the following info and can skip to the signature.
Share any skills, talents, and certifications you have that could be utilized in our camp.
Describe all previous experience that you have had with children ages 5-13. Specify the role that you played, the ages of the children, and how often you helped care for them.
Reference #1
Name (Reference #1)
First NameLast Name
Phone Number
Area CodePhone Number
Relationship to applicant
Reference #2
Name (Reference #2)
First NameLast Name
Phone Number
Area CodePhone Number
Relationship to applicant
Please be aware that you will need to be fingerprinted before you can work as a counselor, which is a Federal and State requirement for a criminal background check.
Signature
Date of Signature
MonthDayYear
Should be Empty:

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Camp Gan Izzy Counselor Application Form