The Anglican Diocese of Ontario Counsellor-In-Training Program Employment Application Summer, 2016 90 Johnson Street Kingston, ON K7L 1X7 Phone Number: 613-544-4774; x 122 Fax: 613-547-3745 hyanto@ontario.anglican.ca Please note: All sections of this application must be completed, even if you are attaching a resume. Use extra paper if necessary; please print or type clearly. Indicate the session for which you are applying and whether you would be available for the other session, if your desired month becomes full (See Below). Camping Session Options: Please choose one of the options below. If you are flexible on the session, please indicate your 1 st and 2 nd option. Regardless of the option chosen, all CIT s are required to attend and participate in the Staff Training Week. For those CIT s in Option 1, Camp Closing is optional. For those CIT s in Option 2, the Camp Closing Week is mandatory. Option 1: Option 2: Staff Training 2016 (26 June to 02 July); First 4-week Term (03 July to 30 July) Staff Training 2016 (26 June to 02 July); Second 4-week Term (02 August to 27 August) Staff Closing Week is from the 28 th August to 2 nd September 2016. Personal Data Last Name Given name (s) Address: Street Apt. # Home Telephone Number City Province Postal Code Business Telephone Number (if applicable) Page 1 of 5
Are You Legally Eligible to Work in Canada? Yes No Are You between the Ages of 16 and 65? Yes No Have You Ever Been Convicted Of A Criminal Offence For Which A Pardon Has Not Been Granted? Yes No Are You Fluent In English? Do You Speak French, Or Any Other Languages? If So, Which Ones? Do You Regularly Attend A Christian Church? Yes No (Please state name of Church): What Is Your Involvement Level With That Church? Education Provide The Following Information Outlining Your Formal Education: Course of Study Diploma / Degree Attained Dates High School: Other: NOTE: If you are currently in the middle of a program, either through a Secondary School Institution or some other equivalent program, please indicate what year you are currently in. Employment List Your Three (3) Most Recent Employment or Volunteer Positions Below: Position Company / Location Dates Phone # Page 2 of 5
Position Company / Location Dates Phone # Experience List Any Previous Camp Experience: Camp Year(s) Camper: Leader-In-Training (LIT): Counsellor-In-Training (CIT): Check The Activities With Which You Have Experience: Archery Arts & Crafts Aquatics Canoeing Drama Dance Worship Nature / Ecology Music Orienteering Campfire Kayaking Hiking Backpacking Knot Tying Ropes Courses Sports Outdoor Living Survival Skills Have You Specialised In Any Of The Above, Or Hold Any Awards Or Certificates? If YES, please list below: Page 3 of 5
Certification Check The Certifications You Currently Hold: ORCKA Which Level? First Aid CPR Red Cross Instructor RLSSC National Lifeguard RLSSC Instructor Wilderness Rescue and First Aid List Any Other Certificates You Hold: NOTE: Please Include Copies Of Your Certificates and/or Awards With This Application. Are You Willing To Renew Or Obtain These Certifications As Necessary Prior To The Summer? Yes No Please Note: If you as an applicant have any extra information on various awards, certifications, or life accomplishments that you feel would enhance your application, please photocopy these documents and attach them with this employment application. References Provide a list of at least three (3) references. Relatives may NOT be used; all references must be over the age of 18. Please have each reference listed fill out the appropriate Camp Hyanto Recommendation form and include the completed forms with your application. Return your application/resume and all recommendation forms directly to the office. Parish Priest/Minister/Chaplain: Employer/Guidance Counsellor/Instructor: Other: Nature of Relationship: Page 4 of 5
For Employment References May We Approach: Your present / most recent employer? Yes No Any of your former employer(s)? Yes No Requirements and Release Please read the following CAREFULLY before signing and submitting this application. I hereby certify that the above information is true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application shall be sufficient cause for dismissal. I authorise Camp Hyanto to investigate the accuracy and completeness of this information. I also release from liability or damage those individuals, educational institutions or corporations who provide information relating to my prior employment or character. I understand that, if employed, I will be required to submit a criminal reference check and to sign, accept and abide by the Camp Hyanto policies, procedures, rules, regulations and that any infringement of these shall be sufficient cause for dismissal. Signature of Applicant Date Signature of Parent / Guardian Date Page 5 of 5