Mail To Jeff & Lonnie Lorenz 25 Baybrook Ln Oak Brook Il. 60523 630-654-8036

Print this application and mail in

Todays Date____________

Applicant Information Name:________________________________Social Security #:__________________________________ Address:___________________________Town, State, Zip________________________Phone#:_____________ Age:__________ Birth Date:___________________ Sex________ Drivers#:_____________________

Education High School Attending:________________________________________________________________________ Year in School_____________________ GPA____________________ Favorite Classes_______________________________________________________________________ Additional School Activies_______________________________________________________________

Activities Put a #1 before those activities you can organize and teach, Put a #2 before those activities you can assist in teaching and organizing, Put a #3 for those activities that are just hobbies, leave blank any activities that you have no skill in. ___Fishing ___Hiking ___Riflery ___Overnight Camping ___Knots ___Canoeing ___Swimming ___Weather ___Crafts ___Discussion Leading ___Backpacking ___Skits ___Ecology ___Pet Care ___Geology ___Oreintering ___Stars ___Soccer ---Volleyball ___Song Leading ___First Aid ___Camp Cooking ___Newspaper ___Sailing List the 3 activities you are most able to teach:_________________________________________________________ List Certifications and Expiration dates:_____________________________________________________________ List Area you would like to learn:_________________________________________________________________

REFERENCES We require two references to be completed on the Referral Application and sent in with this application or mailed directly to the address above. The two references should include: one from a counselor you worked with over the summer,and, and one from an employer, association, charity, or other organization you are a member of. You may obtain the Referrence Form from the First page of this website

Essay Questions The below essay questions are used to help us make an informed decision that you are that someone special, we want motivating and influencing young campers. Please use additional paper for your answers. WHAT WAS THE BEST PART OF BEING A CIT? HOW HAVE YOU GROWEN BY BEING A CIT? WHAT WAS THE HARDEST PART OF BEING A CIT? DID YOU GET PROPER TRAINING? IF NOT WHY AND HOW SHOULD WE CHANGE LIST 2 THINGS THAT YOU FEEL YOU DID HANDLE PROPERLY, NAME THE SITUATION, WHAT YOU DID AND WHAT YOU WOULD DID THAT MADE IT WORK SO WELL. LIST 2 THINGS THAT YOU FEEL YOU DID NOT HANDLE PROPERLY, NAME THE SITUATION, WHAT YOU DID AND WHAT YOU WOULD DO DIFFERENTLLY. WHAT ONE SITUATION UPSET YOU THE MOST THIS SUMMER AT CAMP? HOW WOULD YOU DESCRIBE THE ROLE OF A CIT TO A FRIEND? WHY DO YOU WISH TO RETURN TO CAMP? WHAT ONE SITUATION MADE BEING A CIT ALL WORTHWHILE? DO YOU SEE YOURSELF BEING AN COUNSELOR IN THE FUTURE? ANY ADDITIONAL COMMENTS YOU WOULD LIKE TO MAKE?

 

Your Agreement Have you been criminally convicted of any any child abuse, pornography or any other felony? Y/N_____ If yes please explain.______________________________________________________________ May we conduct a personal background check including contacting references you named and or a criminal background check as may be required for some positions? Y/N________ If no why not?___________________________________________________________________ I have read all the information contained in the CIT/Jr. Counselor Guide and understand that being a Jr. Councelor is a huge responsibility and I am attending camp not as a camper but as a role model for younger campers. I am willing to give of myself to help them grow and develop and enjoy camp.. I submit that all the information on this application is true and complete, I am a U.S. citizen or am legally able to work in this country. Any false or missing information may disqualify me for this position.   Signature______________________________ Date___________