CIT Application

Personal Information:

First name

Last name

Birthday

Month

Day

Year

Phone Number

VP (if you have one)

Address

Staff Positions:

To be considered for a CIT position, you must be available to work from Thursday, July 3rd beginning at 10:00 AM until Saturday, July 13th ending at 5:00 PM.

Additionally, all staff positions require physical ability to lift heavy objects and ability to stand for long periods of time.

Are you able to meet this requirements for a paid position?

YES

Employment History:

Position & Employer:

Start and End Date:

Employer Phone Number:

Position & Employer:

Start and End Date:

Employer Phone Number:

Indicate any employer you do not want us to contact and the reason:

References:

Reference 1 (Name and Relationship)

Reference 1 (Phone Number)

Reference 2 (Name and Relationship)

Reference 2 (Phone Number)

Reference 3 (Name and Relationship)

Reference 3 (Phone Number)

Educational History:

What is the highest level of education you have achieved?

What skills do you have that may come in handy for camp? Please be specific.

Tell us about any summer camp experience you may have. (camper or staff)

Communication Skills:

Sertoma Camp Endeavor, Inc., is a privately supported non-profit program for the Deaf and Hard of Hearing. An ability to communicate with Deaf and Hard of Hearing participants is essential.

Have you taken ASL courses or other Deaf-related courses? if yes, please explain.

Certifications/Licenses:

Do you have a valid Driver's License?

YES

Do you have a CPR/First Aid certification that will be valid during this year's encampment?

YES

Do you have a Lifeguard certification that will be valid during this year's encampment?

YES

Do you hold any valid Sign Language Interpreting Certifications or Evaluations?

YES

If yes, please tell us what interpreting credentials you hold.

Please list any other certifications that may be relevant.

Emergency Contacts:

1st Emergency Contact (Name and Relationship)

Phone Number

2nd Emergency Contact (Name and Relationship)

Phone Number

CODE OF CONDUCT

I understand that the following are prohibited at Sertoma Camp Endeavor: alcohol, tobacco, or illegal drugs, discriminatory comments, violence, sexual conduct, and inappropriate clothing and jewelry. I understand that the applicant is responsible for his/her conduct at all times and must comply with safety regulations, environmental protections policies, and behavior standards of Sertoma Camp Endeavor. I understand that any violation of the above will be grounds for termination WITHOUT PAY, and depending on the severity of the violation, may be reported to law enforcement.

In the past, Camp Endeavor has had a serious issue with campers and some staff excessively talking, WITHOUT the use of sign language- this causes D/HH campers and staff to feel “left out”. Because we are a camp that focuses on the D/HH community, this is unacceptable. To encourage a Deaf-friendly environment at camp and to set a GOOD EXAMPLE for campers, staff will be expected to use Sign Language, to the best of their ability, AT ALL TIMES. Staff members who are warned repeatedly will be terminated. Those who are learning will be given flexibility but are expected to try their best.

By signing and submitting below you agree that you have filled out the application honestly and to the best of your ability. Additionally, should you acquire a position with Sertoma Camp Endeavor you agree to follow the guidelines and code of conduct provided to you to the best of your ability.

Signature

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