2010 Georgia 4-H Summer Camp Counselor Application -- Form B

This application is for experienced counselors (those having served a season or more in the Georgia 4-H Camping Program) who are seeking a camp counselor position in the Georgia 4-H Camping Program in 2010. The Georgia 4-H Camping Program operates at Georgia's five 4-H centers: Burton 4-H Center on Tybee Island, Fortson 4-H Center, Jekyll Island 4-H Center, Rock Eagle 4-H Center and Wahsega 4-H Center.

VERY IMPORTANT: ALL APPLICANTS FOR EMPLOYMENT AS A GEORGIA 4-H SUMMER CAMP COUNSELOR WILL BE INTERVIEWED AS A CONDITION OF EMPLOYMENT. INTERVIEWS WILL BE SCHEDULED FOR A SINGLE DAY IN THE DECEMBER 1, 2009 - JANUARY 8, 2010 TIME FRAME. APPLICANTS MUST MAKE THEMSELVES AVAILABLE FOR INTERVIEWS ON THE SCHEDULED DAY; HARDSHIP CASES WILL BE CONSIDERED ON A CASE-BY-CASE BASIS.

THIS APPLICATION IS DUE FRIDAY, OCTOBER 30, 2009. Please submit this form by the due date, even if you are uncertain at that time you will be able to accept a position if offered.

* Required

Interviews *

I understand that I must be interviewed to be considered for a position as a 4-H summer camp counselor in 2010 and will be expected to attend interviews on the scheduled day, barring unforeseen circumstances.

Name *

County

District

Northeast
Northwest
Southeast
Southwest

Primary Phone * Please list the number at which you receive most of your calls, with area code in this format: xxx-xxx-xxxx

Second Phone * Please use this format: xxx-xxx-xxxx

Third Phone Please use this format: xxx-xxx-xxxx

Primary E-Mail Address * Please list the e-mail address at which you receive most of your e-mail

Second E-Mail Address

Mailing Address * Please give the address where you wish to receive U.S. Mail notifying you of an employment offer. This notice would be sent after Christmas up until the last week of January 2010.

Address Line 2

City, State, ZIP *

County Extension Agent/Program Assistant

County Extension Agent/Office E-Mail Address

What job do you wish to apply for in 2010? -- First Choice *

What job do you wish to apply for in 2010? -- Second Choice *

What job do you wish to apply for in 2010? -- Third Choice *

I am a Certified Lifeguard and received my certification after January 1, 2008 *

Conduct Statement *

I agree to adhere to the standards of conduct required of Georgia 4-H camp counselors and other rules and policies established by the University of Georgia, UGA Cooperative Extension, Georgia 4-H, and Georgia's 4-H Centers as a condition of my employment.