Counselor/Contractor Application PERSONAL INFORMATION First, Last Name: Gender: -Please Select- Female Male Address: City,State,Zip: OH KY IN MI Phone (C): Phone(H): E-mail: Parent Phone (C): Parent E-mail: Birth Date (M/D/YYYY): Age Level: -Please Select- Under 16 16-17 yrs. 18 or older Shirt Size: -Please Select- Adult Small Adult Medium Adult Large Adult X-Large Adult XX-Large Are you eligible to work in the US?: -Please Select- Yes No Have you been convicted of or plead no contest to a felony within the last 5 years?: -Please Select- Yes No Have you ever been convicted of a crime including sexual abuse?: -Please Select- Yes No If yes to either question, please explain Have you worked for Laffalot Summer camps?: -Please Select- Yes No if yes, what years?: EDUCATIONAL INFORMATION Present School Attending: Year of Graduation: Grade School Attended: EMPLOYMENT HISTORY Most Recent Employer: Phone Number: Responsibility: May we contact your recent employer: -Please Select- Yes No REFERENCES (Employers, Teachers, Etc. Please No Family or Freinds) Name: Phone Number: Relationship: Name: Phone Number: Relationship: Name: Phone Number: Relationship: May we contact your references: -Please Select- Yes No AVAILABILITY Please list weeks you are NOT available to work: READ AND INITIAL EACH PARAGRAGH, THEN SIGN AND DATE BELOW I have read and agree to the First Paragraph (Check box and sign with initials) I have read and agree to the Second Paragraph (Check box and sign with initials) I have read and agree to the Third Paragraph (Check box and sign with initials) The undersigned also understands that photographs and/or videos of the undersigned or family members participating in a Laffalot Summer Camp program may be taken for use in promoting Laffalot Summer Camps in future publications and promotions. Applicant's Signature: Parent's Signature: Date (M/D/YYYY):