COUNSELOR IN TRAINING APPLICATION


Name *
Name
Address *
Address
Phone *
Phone
Birthdate *
Birthdate
List previous employer, dates of employment and position held.
List any previous camp experiences. Include camp name, summers, and if camper or staff.
Give name and addresses of three persons (such as former employers, not relatives or classmates) who have knowledge of your character, experience and ability. Please list name, company/organization, phone number and email address.
Consent for References
I give my consent for Camp Whitman on Seneca Lake to seek reference checks from the above individuals and/or groups.
Affirmation of Sexual Conduct
As one who will be working with children and youth at Camp Whitman, if hired, I affirm I have never been convicted or plead guilty of sexual misconduct, sexual abuse, or child molestation.