Application for Summer Employment

Woodbury Parks & Recreation

= = = &nb= sp; P.O. Box 21, Highland Mills, NY 10930

&= nbsp; &nbs= p; Phone: 845-928-9588, Extension 6

= = Fax: 845-928-8240=

&nb= sp; = &nb= sp; Email: parknrec@optonline.net

&= nbsp; &nbs= p; Website: www.woodburyparknrec.com

= APPLICATION FOR CIT (Counselor in Training)

Date:_________________

(PLEASE PRINT)

NAME: = _______________________________________________________________________

&= nbsp; &nbs= p; Last &= nbsp; &nbs= p; &= nbsp; First &= nbsp; &nbs= p; &= nbsp; Middle Initial

HOME ADDRESS: _____________________________________________________________

   &= nbsp;           &nbs= p;             ______________________________________________________________<= /o:p>

AGE: _____________ DATE OF BIRTH: _________________= PHONE NO.: _______________

SOCIAL SECURITY NUMBER: ________________________

EDUCATION:

   &= nbsp;           &nbs= p;        SCHOOL        &= nbsp;           &nbs= p;            FROM        &= nbsp; TO

   =             &nb= sp;            =             &nb= sp;            =                  MO/YR      MO/YR

________________________________          ________<= span style=3D'mso-spacerun:yes'>     ________

ELEMENTARY

________________________________         ________    ________

MIDDLE SCHOOL

REFERENCES:

LIST THREE REFERENCES WITH THEIR ADDRESSES AND TELEP= HONE NUMBERS (MUST BE SOMEONE OTHER THAN A RELATIVE OR FRIEND. TEACHERS, CLERGYMEN, PREVIOUS EMPL= OYERS ACCEPTABLE)

        =     NAME AND TITLE   &nbs= p;            &= nbsp;            = ADDRESS     = ;            &n= bsp;            =    TEL. NO.

1. _________________________     _____________________________ = _______________

   _________________________     _____________________________     _______________<= o:p>

2. ________________________ ____________________________        ________________<= /b>

   ________________________      _____________________________    ________________<= /o:p>

3. _______________________       _____________________________    ________________<= /o:p>

   ________________________      _____________________________    ________________<= /o:p>

=

EMPLOYMENT:

=

   &= nbsp;        ARE YOU CURRENTLY EMPLOYED?   &= nbsp; _______YES        =           _______NO

   =             &nb= sp;            =             &nb= sp;            =             &nb= sp;

   =             &nb= sp;            =             &nb= sp;            =                      = ______FULL TIME        _______PART TIME

LIST YOUR LAST THREE EMPLOYERS STARTING WITH YOUR CURRENT/MOST RECENT POSITION:

    ADDRESS                   =          FROM            =    TO

   =             &nb= sp;            =             &nb= sp;            =             &nb= sp;              =              =                MO/YR=         =    MO/YR

1. ______________________        ___________________________     _______         _______

=

2. ______________________       ____________________________    _______         ________

3. ______________________      ____________________________     _______         ________

HEALTH:

=

HAVE YOU ANY PHYSICAL DISABILITIES, ALLERGIES, ETC? ____________________________

____________________________________________________________________= ___________________________

PERSONAL ACHIEVEMENTS OR AWARDS _________________________________________________

EARLIEST DATE AVAILABLE TO WORK= ? MAY __________________OR= JUNE _______________

CAN YOU WORK THROUGH LABOR DAY? _________________ IF NO, UNTIL WHEN? _________

TELL WHY YOU WANT THIS JOB AND WHY YOU CONSIDER YOU= RSELF QUALIFIED:

___________________________________________________= __________________________

___________________________________________________= __________________________

___________________________________________________= __________________________

___________________________________________________= __________________________