Today's Date

MM

DD

YYYY

Which camp session(s) you would like to apply for? Priority will be giving to applicants who can work all four weeks. *

Camp Session 1 - July 8-12

Camp Session 2 - July 15-19

Camp Session 3 - July 22-26

Camp Session 4 - July 29-Aug 2

Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

(###)

###

####

May we contact the employers listed above for work references? *

(Qualified applicants will require a background check)

Yes

No

Summer camp work involves close contact with children. Have you ever been investigated, arrested or convicted of Child Abuse, Neglect or Related Charges? *

Yes

No

Drug or Alcohol Charges? *

Yes

No

Have you ever been convicted of any other criminal activitiy? *

Yes

No

I certify that all information given on this application is true and I authorize investigation of all statements and information given in this application. I understand that misrepresentation or omissions of facts is cause for dismissal. I also authorize Social Justice Summer Film Camp to secure an employment screening profile, including a criminal/background check and authorize the release of or securing of information for this purpose. *

Agree

Disagree

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone Number *

(###)

###

####