Other Staff Application

Camp Gan Izzy Staff Application Form
Full Name
First Name Last Name
Position Applying For

LifeguardSports CoachGeneral AssistantOther (describe below)
Age
Birth Date

Month Day Year

Address

Applicant's Cell PhoneNumber

Area Code Phone Number
Applicant's E-mail
Grade Entering NEXT year 2024/2025
School NEXT year 2024/2025
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
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.
Share any skills, talents, and certifications you have that could be utilized in our camp.
Reference #1
Name (Reference #1)
First Name Last Name
Phone Number

Area Code Phone Number
Relationship to applicant
Reference #2
Name (Reference #2)
First Name Last Name
Phone Number

Area Code Phone Number
Relationship to applicant
Signature
Date of Signature

Month Day Year
Should be Empty:

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Camp Gan Izzy Staff Application Form