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Remember to TAB between fields, do not press ENTER!

Please review the CIT Program Outline before completing this form.

First & Last Name Sex  M F Age Birthdate 
Home Address  
City/Town Prov/State Postal/Zip CodeTelephone
e-mail address (REQUIRED TO RECEIVE A REPLY) 

					
						
						
						

						
						
						
				
Education:  Secondary School  Current Grade 

References (outside family, preferably teacher and athletic coach)
Name   Relationship to You  Telephone   Email 
Name   Relationship to You  Telephone   Email 
Note:  Reference will be emailed a web link to complete references.  Email address is required.

Most Recent Employment
Employer From toTelephone 
Type of Work Supervisor 

					
						
						
						

						
						
						
				
Which CIT Session would best fit your schedule?
Session One:  June 29 - July 26       Session Two:  July 26 - Aug. 23 
Would you be able to attend either session?  Yes   No 

Please identify all extracurricular activities (athletic teams, clubs, student council, social organizations, etc.) and your role within the activity (team captain, president, committee member,etc.). 

Years	Extracurricular Activity	Role Within Activity

Please identify all volunteer work (coaching, mentoring, teaching, etc.)

Years	Volunteer Organization	Volunteer Position

Please explain your personal experience as a camper (including name of camps attended) and your interest in working within the camp community (200 words or less)

Given the program outline, what would you like to achieve by attending our CIT program? (100 words or less)

Please Check the Certificates You Have That Will Be Valid Until August 31/08
Aquatic:
Bronze Medallion    Bronze Cross     N.L.S.   Instructors
First Aid:
Emergency First Aid   Standard First Aid    Aquatic Emergency Care    C.P.R.    AE Defibrillation 
 

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Interviews
CIT interviews are being held in several locations this winter.  It is our hope that one of these times will work into your winter schedule.  Dates for Southern Ontario and the Toronto area are listed below.  Interviews for all other locations besides Toronto will be set up after we know the number of applicants for each area.

Please indicate your interview preferences, in order of priority... I would like an interview 
							
							
								
							
							
							
								
							
							in Toronto
							
							
								
							
							in Detroit
							
							
								
							
							in Guelph
							
							
								
							
							at HOC
							
							
								
							
							in North Bay
							
							
								
							
							in Ottawa
							by Sudbury
						
							
								
							
							in Buffalo
							in Windsor
							over the Phone
							Other
						
							
						
						 
If your interview is in Toronto, complete the following information, otherwise, apply and we will contact you regarding your interview date & time. 
I would like my Toronto interview to be on 
						
						December 14 - Evening
						December 15 - Morning
						December 15 - Afternoon
						-----------------
						January 18 - Evening
						January 19 - Morning
						January 19 - Afternoon
					. 
My second choice would be on .
							
							
							
							
							December 14 - Evening
							
							December 15 - Morning
							
							December 15 - Afternoon
							
							-----------------
							
							January 18 - Evening
							
							January 19 - Morning
							
							January 19 - Afternoon
						
						 
Toronto interviews will be held at the Quality Suites, Toronto Airport 262 Carlingview Dr.  Hotel Phone Number is 416-674-8442.
Click Here for hotel information and location.

We will contact you with the exact time after we receive your application. Please list here any specific requests regarding interviews: 

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We encourage you to submit a resume to support this application.  Please forward any resumes to mike@learnhockey.com

    * Applications without a valid email address will not receive a reply