Name

First Name

Last Name

Gender

Date of Birth

YYYY

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

School Attending

Years at Shiloh

Have you worked as a CIT before?

If so, how many years?

Return CIT: What is something you would change about the role of the CIT at camp, or a way to improve the CIT program?

Emergency Contact #1

Parent or Guardian

First Name

Last Name

Relationship

Emergency Contact Number

(###)

###

####

Emergency Contact #2

First Name

Last Name

Relationship

Parent or Guardian

Emergency Contact Number

(###)

###

####

Reference Name

An adult over 21 (Coach/employer/teacher). Please let your reference know we will contact them.

First Name

Last Name

Reference Number

(###)

###

####

Tshirt Size

X-Small

Small

Medium

Large

X-Large

2X-Large

3X-Large

4X-Large

Please check the positions you are interested in:

Activities Staff Assistant

Administrative Staff Assistant

Aquatics Staff Assistant

½ Summer Kitchen Staff Assistant

Maintenance Staff Assistant

Climbing Tower Staff Assistant

Nurses Station Assistant

Any Position

How did you hear about Shiloh, and what previous experiences have you had with Shiloh?

What work/contact you have had with children in the last 3 yrs (include any work at camps/childcare)? What were the ages you worked with?

What do you believe is expected from you as a CIT and what do you expect from the other staff members?

What do you think will be your greatest strength as a CIT and what could be difficult for you?

How do you think you can contribute to showing Jesus' example and Christian values to the campers at Shiloh?

Values like love, joy, patience, hope, etc.

Think about someone you consider a good leader. Who is it? In a few sentences describe what you think makes that person a good leader.

Camp Policy

1. Staff members and CITs should not have any romantic, flirtatious, or intimate contact with children or campers at any time. 2. Hitting a camper or another staff member/CIT for any reason will not be tolerated and will result in immediate dismissal. 3. Staff members are not allowed to leave camp property during camp session unless permission is given by CIT Director. 4. Any use of, or being under the influence of, illegal drugs, alcohol, marijuana, or tobacco products is strictly prohibited. Any use of the aforesaid items will result in immediate dismissal. 5. No sexual contact or intercourse will be tolerated and will lead to immediate dismissal.

After reading the Camp Policies do you understand and agree to adhere to these policies?

Are you legally employable under the U.S. Immigration Laws?

Have you ever been convicted of any crime?

If yes, please explain:

Signature

I authorize Camp Shiloh, Inc. to receive information from any law enforcement agency to the extent permitted by state and federal law, pertaining to any convictions I may have had for violations of state or federal crime laws, including but not limited to convictions for crimes committed upon children. I understand that this is for the purpose of considering my application as an employee or volunteer, and this information will remain confidential, not to be provided to anyone outside the Camp Shiloh, Inc. organization. Please sign below to indicate your authorization to the paragraph above, and the following: I understand that by initialing this application, and upon my acceptance of employment, I agree to abide by the policies and procedures as set forth by New York State camping regulations and by Camp Shiloh.

Today's Date

YYYY

CIT TEEN APPLICATION