RFK NEW COUNSELOR/STAFF APPLICATION
Instructions: All information is held strictly confidential. This form must be completely filled out. The information is vital to your acceptance and possible placement as a counselor or staff member. For any questions contact Camp Director, Lisa Bly at 414-614-0674 or email her at
Help us get to know you..
Drivers License Number
Social Security Number
Name of Employer
Number of Years
Is this your Home or Cell Number?
How many years have you lived in Wisconsin?
If you have lived in WI for less than one year, list your complete addresses for the last five years:
Emergency Contact and Number
Emergency Contact Relationship
Adult T-shirt Size
Do you have certification in the following?
Do you have previous training or background in dealing with abused, neglected or abandoned children?
If yes, please specify:
Have you in your lifetime experienced abuse, neglect, trauma, or violence?
If yes, please explain:
Which position are you applying for?
Please describe why you wish to be a counselor or staff person working with abused and neglected children:
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service