2023 YCS Summer CIT Application

Name Name * First Last
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Cell Phone Cell Phone - ### - ### ####
Home Phone Home Phone - ### - ### ####
Email *

Confirm Email Address *
T-Shirt Size *

T-Shirt Size Small Medium Large X-Large 2X
List any current certifications you have acquired (Lifeguard, CPR, First Aid, Babysitting, EMT, Bus Driver, etc..)
What age group would you prefer to work with? *

What age group would you prefer to work with? Ages 6-8 Ages 9-12 Other Other

Choose all that apply
List all job positions you have held (include dates of employment along with supervisor's name, phone number, and email address). Write "None" if this would be your first job. *
SCHEDULING SECTION
Which two-week session(s) are you available to volunteer? *

Which two-week session(s) are you available to volunteer? Session 1: June 20 - June 30 Session 2: July 3 - 14 (no camp 7/4) Session 3: July 17 - July 28 Session 4: July 31 - August 11

Choose all that apply

List the sessions in order of your preference *
	First Choice	Second Choice	Third Choice	Fourth Choice
Session 1: June 20 - June 30	Session 1: June 20 - June 30First Choice	Session 1: June 20 - June 30Second Choice	Session 1: June 20 - June 30Third Choice	Session 1: June 20 - June 30Fourth Choice
Session 2: July 3 - 14 (No camp 7/4)	Session 2: July 3 - 14 (No camp 7/4)First Choice	Session 2: July 3 - 14 (No camp 7/4)Second Choice	Session 2: July 3 - 14 (No camp 7/4)Third Choice	Session 2: July 3 - 14 (No camp 7/4)Fourth Choice
Session 3: July 17 - 28	Session 3: July 17 - 28First Choice	Session 3: July 17 - 28Second Choice	Session 3: July 17 - 28Third Choice	Session 3: July 17 - 28Fourth Choice
Session 4: JUly 31 - August 11	Session 4: JUly 31 - August 11First Choice	Session 4: JUly 31 - August 11Second Choice	Session 4: JUly 31 - August 11Third Choice	Session 4: JUly 31 - August 11Fourth Choice

REFERENCE INFORMATION
Reference #1 Name Reference #1 Name * First Last
Relationship *
Phone Phone * - ### - ### ####
Email *
Reference #2 Name Reference #2 Name * First Last
Relationship *
Phone Phone * - ### - ### ####
Email *
Reference #3 Name Reference #3 Name * First Last
Relationship *
Phone Phone * - ### - ### ####
Email *
SCHOOL INFORMATION
High School Name *
Year of graduation or expected graduation
Please include any additional information about yourself such as ability to speak another language, special skills, music/theater experience, interests, awards received, community service, etc... *
Tell us about any experience you have working or volunteering with children *
Tell us why you would like to be a CIT for Yarmouth Community Services *
What is your personal philosophy on the role that youth programs/sports play in the lives of children? *
Town of Yarmouth / Yarmouth Community Services Background Check Authorization
By singing below I understand that in order to assess my qualifications for the position of camp counselor, a full criminal background investigation is necessary. I, therefore, authorize the Town of Yarmouth/Yarmouth Community Services to conduct an investigation in order to obtain information concerning my criminal background.

I understand that a consumer report may be prepared summarizing the above information. I may request a copy of any report that is prepared regarding me from the consumer reporting agency and may also request the nature and substance of all information about me contained in the files of the consumer-reporting agency. I understand that proper identification will be required and that I should direct my request to:

Equifax Credit Information Services, Inc
P.O. Box 740241
Atlanta, GA 30374

I hereby release any individual, entity and the municipality from all claims of liabilities that might arise from the inquiry into or disclosure of such information, including claims under any federal, state, or local civil rights law and any claims for defamation or invasion of privacy.

All the information and materials I have provided to the Town of Yarmouth as part of the employment process are accurate and truthful. I realize that providing the municipality with false information or intentionally withholding relevant information regarding my application may be grounds for dismissal.
Do you agree to the request stated above? *

Do you agree to the request stated above? Yes, I agree No, I do not agree
Your Full Legal Name Your Full Legal Name * First Middle Last
Maiden Name (if applicable) Maiden Name (if applicable) First Middle Last
Date of Birth Date of Birth * / MM / DD YYYY
Certificate of Applicant

Read Carefully Before Signing - I hereby certify that all statements in this application are true and complete and that any misstatement or omission of material facts may subject me to disqualification or dismissal.
Draw your signature into the box below.

Clear

2023 YCS Summer CIT Application

2023 YCS Summer CIT Application

SCHEDULING SECTION

REFERENCE INFORMATION

SCHOOL INFORMATION

Town of Yarmouth / Yarmouth Community Services Background Check Authorization

Certificate of Applicant