IMPACT 2020 Worker Application

IMPACT Security/Roadie Application
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Email will be used for communication. Please be sure to check it regularly.
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Phone Numbers:
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School:
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Home Address:
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Personal Information
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Do you have a medical condition that could affect your ability to serve as a counselor, security, or roadie?
Are you taking prescription drugs?
Have you ever been convicted of a crime other than a minor traffice violation?
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References:
List two adults unrelated to you as references. You MUST include a phone number.
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Read the statements below. You must click "Yes" in the appropriate space to complete the application process.
I agree to abide by all counselor requirements, responsibilities, and policies as specified in this application, as supplied at training sessions and as supplied during the camp session.
I understand that in applying for an IMPACT staff position, the information I have furnished on this application is subject to a background check and verification. I affirm that all statements and information in this application, to the best of my knowledge, are true, correct and complete as of the date indicated by my name below. If any information changes, I will immediately notify IMPACT of any such changes.