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Counselor-In-Training Application

Summer Camp 2025

Name:

Preferred Name:

Address:

City:

State:

Zip Code:

Phone:

Email:

Age 18 or older?

Yes No

Relative Employed by the Council?

Yes No

If relative employed, name:

Desired Start Date

Have you ever been employed by the Council? If so, when?

How were you referred to the Council?

If referred by an individual/organization, give their name.

List all specialized skills and training applicable to the position for which you are applying.

Highest Degree:

GPA:

Graduated?

Yes No

Major:

School:

Location:

License or Certificate:

Issue Date:

License Number:

Issued by:

State/Country:

Expiration Date:

Last Employer:

May we contact your current employer?

Yes No

Address:

City:

State:

Zip Code:

Supervisor Name:

Phone:

Start Date:

End Date:

Ending Pay Rate:

Ending Position or Rank:

Reason for Leaving*:

Previous Employer:

Address:

City:

State:

Zip Code:

Supervisor Name:

Phone:

Start Date:

End Date:

Ending Pay Rate:

Ending Position or Rank:

Reason for Leaving*:

Previous Employer:

Address:

City:

State:

Zip Code:

Supervisor Name:

Phone:

Start Date:

End Date:

Ending Pay Rate:

Ending Position or Rank:

Reason for Leaving*:

Have you ever been terminated or asked to resign from any job? (If yes give details in a seperate email)

Yes No

References - Give the names of 3 persons not related to you whom you have known for at least 3 years.

Address, Phone, Email

Company

Years Acquainted

Reference 2

Address, Phone, Email

Company

Years Acquainted

Reference 3

Address, Phone, Email

Company

Years Acquainted

Please read carefully before accepting:

I attest by marking this box that I have given the Quivira Council, Boy Scouts of America, true and complete information on this application. No requested ininformation has been concealed. I authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that the results of any investigation may be disclosed to other employees involved in the hiring process and I consent to the dissemination of the results of any investigation to such employees. I authorize the Quivira Council, Boy Scouts of America, to contact references provided for employment reference checks. If any information I have provided is untrue, or if I have concealed material information, I understand that this will constitute cause for the denial of employment or immediate dismissal. I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for the Quivira Council, Boy Scouts of America, to hire me. If I am hired, I understand that either the Quivira Council, Boy Scouts of America, or I can terminate my employment at any time and for any reason, with or without cause and without prior notice. I understand that no representative other than the Scout executive has any authority to enter into any agreement contrary to the foregoing or make any oral assurance or promise of continued employment.

Applicants are subject to background investigations, including criminal background checks.

In compliance with federal law, all persons hired will be required to verify their identity and eligibility to work in the United States and to
complete the required employment eligibility verification document form upon hire.

COUNCIL INFO

P: 316-264-3386

F: 316-264-6054

Have a question? Get answers at AskQuivira@Scouting.org

Service Centers

3247 N Oliver Ave, Wichita, KS 67220

402 E. Fulton Street, Ste. 4, Garden City, KS 67846

P: 620-275-5162

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