| Applying for |
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| Personal Information |
| * First Name |
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| Middle Initial |
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| * Last Name |
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| * Birth Date |
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| Sex |
M
F
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| Social Security # |
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| Phone # |
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| Cell Phone # |
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| T-Shirt Size |
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| * Email Address |
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| Please note: you will be contacted via e-mail with more information in regard to setting up an interview after we receive this application. Please make sure that you are able to receive incoming e-mail. |
| School Information |
| Name of High School |
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| Grade in Fall 2012 |
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| Permanent Address |
| Line 1 |
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| Line 2 |
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| Permanent City |
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| Permanent State |
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| Permanent Zip |
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| Permanent Country |
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| Live with |
| Parent/Guardian's Name 1 |
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| Parent/Guardian's Phone 1 |
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| Parent/Guardian's Name 2 |
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| Parent/Guardian's Phone 2 |
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| Camp Experience |
| Have you ever been a camper at our Camps |
Yes
No |
| CHK Which year(s) |
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| GHC Which year(s) |
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| If no how did you hear about us |
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| Have you ever attended another camp |
Yes
No |
| Which camp |
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| When you attended another camp |
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| Volunteer/Work experience |
| List previous paid and/or volunteer experience |
| Experience 1 |
| Position 1 |
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| Agency name 1 |
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| Supervisor 1 |
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| Dates worked 1 |
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| Phone number 1 |
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| Brief description of duties 1 |
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| Reason for leaving 1 |
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| Experience 2 |
| Position 2 |
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| Agency name 2 |
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| Supervisor 2 |
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| Dates worked 2 |
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| Phone number 2 |
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| Brief description of duties 2 |
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| Reason for leaving 2 |
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| References |
| List two references whom you have known for at least one year. An email will be sent to each of them with a link to the online reference form. It is up the CIT applicant to follow up with their references to make sure they received the email and have completed and sent in the reference form. Do not include family members. |
| Reference 1 |
| Name (First & Last) |
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| * Email Address |
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| Home Phone |
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| Work Phone |
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| Cell Phone |
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| Relationship |
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| Reference 2 |
| Name (First & Last) |
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| * Email Address |
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| Home Phone |
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| Work Phone |
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| Cell Phone |
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| Relationship |
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| Jewish Background |
| Temple Affiliation |
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| City and State |
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| Are you involved in your Temple Youth Group? |
Yes
No |
| Are you involved in NFTY? |
Yes
No |
| Have you been to Israel? |
Yes
No |
| If yes, what Program? |
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| Jewish Education |
| Bar/Bat Mitzvah |
Yes
No |
| Confirmation |
Yes
No |
| Other |
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| Hebrew Education |
| Do You Speak Hebrew? |
Yes
No |
| Do You Read Hebrew? |
Yes
No |
| Do You Write Hebrew? |
Yes
No |
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| CIT Job Description |
| Qualifications |
- Entering Senior year of High School
- Hard working focused and committed; self-starter and self-motivator, with good time-management skills
- Able to take direction; ability to accept guidance and support; willingness and ability to ask for help when needed
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| Responsibilities |
- Provide support to staff in all areas of camp
- Participate in a study program that includes
- Leadership training
- Jewish study utilizing the Camp’s visiting professionals
- Staff training in counselor skills, cabin management, programming skills and child behavior
- Uphold and abide by the rules and policies of camp
- Work with camper cabins and in specialty programs of camp
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| Personal Statement |
| Please keep your answer to each question to 500 words or less |
| Why do you want to be a part of CIT program this year? What do you hope to learn? |
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| What skills, talents, or experiences do you have from past experiences that will help prepare you to work with campers? |
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| Describe a time when you dealt with a conflict (with an authority or a peer) and explain how you solved it |
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| What do you anticipate being the hardest part of transitioning from camper to CIT? How will you overcome this? |
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| Agreement |
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I hereby acknowledge that the information on this application is accurate and complete. |
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I authorize the Wilshire Boulevard Temple Camps to contact any references and examine any records which may attest to my character. |
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I understand that misrepresentation or omission of the facts called for herein, receipt of unsatisfactory references, or failure to submit a completed health form may be sufficient cause for dismissal even if I shall have been employed. |
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I further understand if I shall be accepted, either of us may terminate our relationship if it is felt I will not meet the program’s demands or show an inability to adapt myself to the requirements and duties of the program. |
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I understand that employment at the Wilshire Boulevard Temple Camps requires work which is physically exerting, on uneven grounds and non-paved, limited access roads. |
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| Today's Date |
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| * Signature of Applicant (type your full name) |
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| This field helps prevent automated access. |
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| Enter the code as it is shown: |
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