Send completed form to: lesleegreenup@greenupcamps.com
GREENUPCAMPS
Counselor Application
APPLICANT INFORMATION
Last Name
First
M.I.
Street Address
Date
Apartment/Unit #
City
State
ZIP
Phone
E-mail Address
Social Security No.
Position Applied for
Basketball Counselor
Are you a citizen of the United States?
YES
NO
If no, are you authorized to work in the U.S.?
Have you ever worked for this company?
YES
NO
If so, when?
Have you ever been convicted of a felony?
YES
NO
If yes, explain
YES
REFERENCES
Please list three professional references.
Full Name
Relationship
Company
Phone
(
)
Address
Full Name
Relationship
Company
Phone
(
)
Address
Full Name
Relationship
Company
Phone
(
)
Address
DISCLAIMER AND SIGNATURE
I certify that my answers are true and complete to the best of my knowledge.
If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.
Signature
Date
NO
Send completed form to: lesleegreenup@greenupcamps.com
Background Check
In order to become a GreenupCamps Counselor, a background check must be
completed. Applicants do have the right to refuse that a background check be conducted, although
refusing to consent to a background check will affect GreenupCamp’s decision. So that this
application may be completed, please fill in the blanks below and sign in the space provided. All
information will be kept confidential, and only those with privilege will review applicant information.
Name (Last, First): __________________________________________________________
Social Security #:___________________
DOB: ____________________
Driver’s License Number: __________________________ Driver’s License State: _______
Aliases or Maiden Name(s): ___________________________________________________
Current Address:
Number/Street: ____________________________ City:_______________
Zip:_______
Previous Address:
Number/Street: ____________________________ City:_______________
Zip:_______
Has the applicant ever been charged or convicted of a crime? (especially sex related)
Yes ___ No___
If yes, please explain:
Signature: _________________________________ Date:___________
Name (printed): _____________________________________________