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Andrew J. Ginther, Mayor
City Council
> Nicholas J. Bankston> Lourdes Barroso de Padilla > Mitchell J. Brown > Rob Dorans > Shayla Favor > Shannon G. Hardin > Emmanuel V. Remy
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Availability for Work Form
(*) - Indicates a Required Field
* Name (First and Last):
* Address:
* City: , OH * Zip:
* Home/ Primary Phone: Work Phone:
Cell Phone: *Email:
* T-Shirt Size (Choose Only 1): M L XL XXL XXXL
* CPR/AED Certified: Yes No If yes, expiration date:
* First Aid Certified: Yes No If yes, expiration date:
* Have you removed your money from OPERS since last summer? Yes No
2016 DatesTraining is from June 6th - June 10th Sports Camp is from June 13th - June 15th Summer Camp is from June 13th - August 5thSwim Camp is from August 8th - August 12thTeen Adventure Camp is from August 8th - August 12th
* Dates available for employment: Staff asked to commit to the entire camp season.
* Please provide dates of requested absences exceeding two (2) days below. (Must be pre-approved.)
From: (Month) (Day) To: (Month) (Day)
* Employment Options: (Please indicate 1st, 2nd and 3rd choice for times.)
7:00AM - 3:00PM 8:00AM - 4:00PM 9:30AM - 5:30PM
* Work Site Preference: (List your 1st and 2nd choice to work this summer.)
Dodge Therapeutic Recreation Camp -OR- Franklin Park Therapeutic Recreation Camp -OR- Thompson Therapeutic Recreation Camp
Electronic Signature:
* I hereby certify (by checking this box) that the foregoing information is accurate and complete: Date: