SECTION 1
I am applying to:
Volleyball
All-Sport
Position(s) for which you are applying:
SECTION 2 Name:
Gender:
Male
Female
Permanent Address:
Street:
Apt:
City:
Province:
Postal Code:
Phone Number 1:
Phone Number 2:
Temporary Address: (For example college)
I will be at this address from:
January February March April May June July August September October November December
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
select
I will be at this address until:
January February March April May June July August September October November December
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
select
Street:
Apt:
City:
Province:
Phone Number 1:
Phone Number 2:
Email Address:
Birthdate
Club Affiliation:
Please be prepared to provide Social Insurance & Health Card numbers at the interview.
SECTION 3
Educational Background:
High School
NA
OAC
12
11
10
College
NA
1st
2nd
3rd
4th
University
NA
1st
2nd
3rd
4th
Post Graduate
High School Name:
City
I was here from:
January February March April May June July August September October November December
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
select
I was here until
January February March April May June July August September October November December
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
select
College or University Name:
City:
Province/State:
Major Subjects:
Degree/Major:
SECTION 4
Camp Background:
Years as a camper:
Last 3 camps attended:
Did you attend a camp CIT/LIT training program?
Yes
No
If yes, which camp(s)?
Camp Staff Background: (if this does not apply, skip to Section 5)
Camp:
Dates (years attended 19xx):
Positions:
Director:
Phone:
SECTION 5
Other Employment:
Employer 1:
Worked here from:
January February March April May June July August September October November December
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
select
Worked here until:
January February March April May June July August September October November December
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
select
Nature of work:
Phone:
Supervisor:
Reason for Leaving:
Employer 2:
Worked here from:
January February March April May June July August September October November December
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
select
Worked here until:
January February March April May June July August September October November December
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
select
Nature of work:
Phone:
Supervisor:
Reason for Leaving:
We require at least 3 references. The Camp Director(s) and employers listed above will be contacted and may be used as reference. If you are providing other references they should not be relatives and should have knowledge of your character, experience and ability.
Reference 1:
Name:
Phone:
Address:
City:
Prov:
What type of reference will the above provide (eg. Camp Director, employer, teacher, clergy etc.)
Reference 2:
Name:
Phone:
Address:
City:
Prov:
What type of reference will the above provide (eg. Camp Director, employer, teacher, clergy etc.)
Reference 3:
Name:
Phone:
Address:
City:
Prov:
What type of reference will the above provide (eg. Camp Director, employer, teacher, clergy etc.)
SECTION 6
Other Certifications:
NLS
Yes
No
Expiry:
January February March April May June July August September October November December
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
select
First Aid
Yes
No
Issuing Agency:
Expiry:
January February March April May June July August September October November December
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
select
CPR (Basic)
Yes
No
Issuing Agency:
Expiry:
January February March April May June July August September October November December
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
select
Special Interests:
What contributions do you think you can make at camp?
What contributions do you think a well run camp can make to a child?
Write a brief note explaining what camp, school or other training and what experiences you have had that will allow you to be successful at the job for which you are applying:
Other comments:
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