Volunteer Application Form Ymca Trout Lodge & Camp Lakewood
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4VOLUNTEER APPLICATION
YMCA TROUT LODGE & CAMP LAKEWOOD
Mail Completed Application to:
Contact Us for Questions:
P 314-241-YMCA or 573-438-2154 ext. 237
YMCA TROUT LODGE & CAMP LAKEWOOD
F 573-438-5752
Attn: Melissa DiFiori
13528 State Highway AA
Potosi, MO 63664
Name: _____________________________________________________________________________________________ E-mail: __________________________________________________________________
Social Security #: ______________________________________________________________________________ Present Phone #: (_________) __________________________________________
Present Address: ___________________________________________________________________________________________________________________________________________________________
Permanent Address: _______________________________________________________________________________________________________________________________________________________
Permanent Phone #: (__________) _____________________________________________ I will be at my present address until: ____________________________________________
Birthday (if under 21) : ____________________________________________________________________ Are you legally entitled to work in the U.S.? q Yes q No
Have you ever been convicted of or pled guilty to a criminal offense? q Yes q No If yes, what was it? _________________________________________
High School Grade Completed: 9 10 11 12 College Year Completed: 1 2 3 4
EDUCATION
Entered
Left
Name
City, State
Mo./Yr.
Mo./Yr
Major
Degree
High School _____________________________________________________ ___________________________ ________________ ___________________ ___________________________ ___________
College/University _____________________________________________ ___________________________ ________________ ___________________ ___________________________ ___________
List school extra-curricular activities: _________________________________________________________________________________________________________________________________
WORK EXPERIENCE
(Please list previous employers BEGINNING with the most recent.)
1. Employer/Company: _____________________________________________________________________________________ Supervisor: _______________________________________________
Address: ______________________________________________________________________________________________________ Telephone: (_________) _____________________________________
Position: ______________________________________________________________________________________________________ Dates Employed: __________________ to __________________
Reason for Leaving: ________________________________________________________________________________________________________________________________________________________
2. Employer/Company: _____________________________________________________________________________________ Supervisor: _______________________________________________
Address: ______________________________________________________________________________________________________ Telephone: (_________) _____________________________________
Position: ______________________________________________________________________________________________________ Dates Employed: __________________ to __________________
Reason for Leaving: ________________________________________________________________________________________________________________________________________________________
3. Employer/Company: _____________________________________________________________________________________ Supervisor: _______________________________________________
Address: ______________________________________________________________________________________________________ Telephone: (_________) _____________________________________
Position: ______________________________________________________________________________________________________ Dates Employed: __________________ to __________________
Reason for Leaving: ________________________________________________________________________________________________________________________________________________________
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Parent category: Business