1.

 Name:

Address:

City ,    Ohio                    Zip Code

Telephone: Home/ with area code   Work / 2nd Number w/ area code

T-Shirt Size     L     X- L     XX-L    XXX-L 

2.

Dates Available for employment (PLEASE BE EXACT)

FROM:     MONTH DAY        TO     MONTH   DAY 

COMMENTS: PROVIDE DATES OF ANY ANTICIPATED ABSENCES EXCEEDING TWO (2) DAYS

FROM:     MONTH DAY        TO     MONTH   DAY 

3.

Times available for employment: (Check one)

From:         7:00 a.m.                    to                6:00 p.m.                    Monday - Friday (8 hour shift)

From:        9:00 a.m.                    to                4:00 p.m.                    Monday - Friday (Playgrounds)

From        9:00 a.m.                     to                6:00 p.m.                     Monday - Friday (Recreation Centers)

From        11:00 a.m.                   to                8:00 p.m.                     Monday - Friday (Evening Programs)

TRANSPORTATION:        Own Vehicle     Access to Vehicle     Other

4.

Work Preference (List your 1st, 2nd and 3rd choice to work this summer)

    Camp                                                                  Playground (Park)

    Playground (Recreation Center)                           Evening Center Programs

    Specialty Camp

I hearby certify that the foregoing information is accurate and complete