Mail To
Jeff & Lonnie Lorenz
25 Baybrook Ln
Oak Brook Il. 60523
630-654-8036

Information

Name:________________________________Social Security #:__________________________________
Address:___________________________Town, State, Zip________________________Phone#:_____________
Age:__________ Birth Date:___________________ Sex________ Drivers#:_____________________

Education
High School Attending:______________________________________
Year in School_____________________ GPA____________________
Favorite Classes___________________________________
Additional School Activies_______________________________________________________________

Volunteer Experience or Organizations
1)Organization: __________________
Position:__________________ Year:_________ Supervisor:___________
Responsibilities____________________________________

2)Organization: __________________
Position:__________________ Year:_________ Supervisor:___________
Responsibilities____________________________________

3)Organization: __________________
Position:__________________ Year:_________ Supervisor:___________
Responsibilities____________________________________

Activities
Put a #1 before those activities you can organize and teach, Put a #2 before those activities you can assist in teaching and organizing, Put a #3 for those activities that are just hobbies, leave blank any activities that you have no skill in.

List the 3 activities you are most able to teach:_________________________________________________________

List Certifications and Expiration dates:_____________________________________________________________

List Area you would like to learn:_________________________________________________________________

REFERENCES
We require three references to be completed on the Referral Application and sent in with this application or mailed directly to the address above. The three references should include: one from a past camp staff members, one from a non-family member, and one from an employer, association, charity, or other organization you are a member of. You may obtain the Referrence Form from the First page of this website

Essay Questions
The below essay questions are used to help us make an informed decision that you are that someone special, we want motivating and influencing young campers. Please use additional paper for your answers.

1) What would you personally like to gain from working at Swift Nature Camp?

2) What would you be eager to teach at camp?

3) What experience have you had with children?

4) What are your personal strengths?

5) What are your personal weaknesses? What do you have troubles with?

6) Tell me about a rule you once had to follow that you thought was stupid? How did you react to that rule?

7) Have you ever had to organize a project or program? What was it and what did you contribute?

8) What rules of life do you feel all should live by? Do you live your life by it? How would you teach it to others?

9) Have you ever had to put someone first? Put their needs before yours? Tell me about that? How did you Feel?

10) Who is your role model or hero? Why?

Personal Characteristics

Your Agreement
Have you been criminally convicted of any any child abuse, pornography or any other felony? Y/N_____
If yes please explain.______________________________________________________________

May we conduct a personal background check including contacting references you named and or a criminal background check as may be required for some positions? Y/N________
If no why not?___________________________________________________________________

I have read all the information contained in the Leadership. Counselor Guide and understand that being a included is a huge responsibility and I am attending camp not as a camper but as a role model for younger campers. I am willing to give of myself to help them grow and develop and enjoy camp. I submit that all the information on this application is true and complete, I am a U.S. citizen or am legally able to work in this country. Any false or missing information may disqualify me for this position.

Signature______________________________ Date___________