ORPR 2024 Assistant Director and Counselor Leadership Application

Applicants Name: *

First Name

Last Name

Present Address:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number: *

(###)

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Position for which you are applying (Please Check) *

Assistant Director

Counselor (Nachal'stvo)

Head of Camp

SKILLS INVENTORY: Please check if you have any of the following skills and/or certifications (Please provide copy of certifications with expiration dates where applicable). *

Singing / Choir

Reading in Church

Altar Server

Certified Lifeguard

Certified First Aid

CPR Certified

Food Service Sanitation License

EDUCATION: Please indicate the most recent level of education you have completed: *

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WORK EXPERIENCE: Please list any work experience you have (paid/volunteer) in the past 5 years.

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PERSONAL REFERENCES: (outside of family members and ORPR Camp Staff). Examples include teachers, couches, volunteer coordinators, etc.... *

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Reference #1 *

First Name

Last Name

Contact Phone: *

(###)

###

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Reference #2 *

First Name

Last Name

Contact Phone: *

(###)

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1. Have you ever been arrested, convicted, or pled guilty to a crime? *

Yes

No

2. Have you ever been suspended or expelled from school? *

Yes

No

3. Have you ever been accused or charged with any act of physical, emotional, or sexual abuse or neglect with regard to any child or teen (any individual 18 years of age and under)? *

Yes

No

4. Have you ever - whether or not you were accused of doing so - engaged in acts of emotional, physical, or sexual abuse or neglect with regard to a child or teen? *

Yes

No

5. Were you a victim of physical, emotional, or sexual abuse or neglect while a child or a teen? *

Yes

No

I would like to be contacted directly to discuss these questions. *

Yes

No

ACKNOWLEDGMENT and SIGNATURE: Please check each statement and sign below. *

The information I have provided on this form is truthful and correct to the best of my knowledge.

I authorize ORPR Camp to verify any information provided by me in this application.

I authorize ORPR Camp to contact my personal references.

If accepted for the position, I understand that I will be required to attend a leadership workshop, to be held prior to the 2024 camp session, at a date and time to be determined.

I understand that I have no expectation of privacy concerning any information disclosed in this form. If I wish to keep any information confidential, I understand that I may only do so by direct request to the Camp President.

DISCLAIMER: By typing your name below, you have read and understood the Code of Conduct and that you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application. *

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Applicants Signature: *

First Name

Last Name

Date: *

MM

DD

YYYY

DISCLAIMER: By typing your name below, you have read and understood the Code of Conduct and that you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

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Parent / Guardian:

First Name

Last Name

Date

MM

DD

YYYY