GIRLS’ STATE COUNSELORS AND STAFF COME FIRST!
Former Girls’ State Citizens or Dedicated American Legion Auxiliary Members:
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They feel Girls’ State is a worthwhile experience and wish to give of themselves.
They feel they could share their Auxiliary Leadership experience with the youth of our state.
They know that the experience of Girls’ State is such a learning experience for themselves and
rewarding beyond words.
They feel the program is one they could become excited about and consider making a one-week
commitment to it in June.
IF YOU WOULD LIKE TO BE CONSIDERED FOR A POSITION ON THE GIRLS’ STATE
STAFF IN JUNE – FOLLOW THE INSTRUCTIONS BELOW:
1. Fill out the questionnaire below:
2. You MUST mail Application, CORI and References to:
Mrs. Bonnie Sladeski
12 Doverbrook Rd.
Chicopee, MA 01022
413-593-1646
Email: Director.massgirlsstate@yahoo.com
THE APPLICATION, ETC. MUST BE RECEIVED NO LATER THAN MARCH 1, 2016.
THE STAFF WILL REVIEW YOUR REQUEST AND CONTACT YOU ON OR BEFORE
APRIL 1, 2016.
APPLICATION FOR A POSITION ON THE 2016 GIRLS’ STATE STAFF!
PLEASE PRINT CAREFULLY
NAME: ___________________________________________________________________
ADDRESS: ________________________________________________________________
CITY: ___________________________________________ STATE:_____ ZIP: _______
PHONE: ________________________________ EMAIL: __________________________
AUXILIARY UNIT # & DISTRICT # (If applicable) ______________________________
OFFICE OR COMMITTEES HELD IN THE AMERICAN LEION AUXILIARY:
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IF YOU ARE A FORMER GIRLS’ STATE CITIZEN – WHAT WAS YOUR CITY/TOWN AT
GIRLS STATE? __________________________________________________________________.
GIRLS’ STATE OFFICES HELD: ___________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________.
ARE YOU FAMILIAR WITH GIRLS’ STATE IN ANY WAY? ____________________________.
IN WHAT WAY? __________________________________________________________________.
LIFE EXPERIENCE – (i.e. BUSINESS, TEACHER, NURSE, CHURCH COMMUNITY, ETC.)
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________.
WHAT POSITION(S) ARE YOU INTERESTED IN APPLYING FOR? (PLEASE GIVE YOUR
TOP THREE CHOICES).
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________.
WE HAVE FREE TRAINING FOR ALL POSITIONS!
Although the campus is modest, we need people who are physically able to maintain our active
schedule and remember we have 270 – 300 “noisy” 16-year old young ladies.
If you would like more information on Girls’ State before submitting the application for a staff
position, please contact Bonnie at the phone number or e-mail give above or check out our web site at
www.massgirlsstate.org.
2 REFERENCES NEEDED:
1. Professional or School Reference
2. Personal Reference (over the age of 18).
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Chapter 6, $ 172H Cori Requst Form
Department of Massachusetts
American Legion Auxiliary
DBA: Massachusetts Girls’ State
State House Room 546-2
Boston MA 02133
Department of Massachusetts American Legion Auxiliary is requesting all the available criminal
offender record information (CORI) on the following individual from the Criminal History Systems
Board pursuant to Chapter 6, $ 172H which mandates organizations primarily engaged in providing
activities or programs to children 18 years of age or less that accepts volunteers, to obtain all CORI
regarding volunteers prior to accepting any person as a volunteer.
__________________________________________
Applicant/Volunteer Signature
VOLUNTEER INFORMATION (PLEASE PRINT)
_____________________
LAST NAME
________________________
FIRST NAME
______________________
MIDDLE NAME
______________________________________
MAIDEN NAME OR ALIAS (IF APPLICABLE)
DATE OF BIRTH: _________________________
SOCIAL SECURITY NUMBER _______ - ______ - _______
(Required)
ADDRESS:
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________.
REQUESTED BY: ___________________________________________________________________________
SIGNATURE OF CORI AUTHORIZED EMPLOYEE
CHSB USE ONLY
RECORD ATTACHED: __________________________
NO RECORD; ________________________
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