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 milwrfkc@yahoo.com.
PERSONAL INFORMATION
Help us get to know you..
Date *
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First Name *
Last Name *
Birth Date *
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DD
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Gender *
Street Address *
City *
State *
Zip code *
Drivers License Number *
Social Security Number
Marital Status
Age
Occupation
Name of Employer
Number of Years
Phone Number *
Is this your Home or Cell Number? *
Email *
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:
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