RYLA 5810 - 2023 Rotarian Staff Application

General Information
Employer & Description of Position (if applicable)
College/Employer Location (City/State)
Employer Contact

First NameLast Name
Employer Phone

Area CodePhone Number
Employer Email
example@example.com
Are You a Rotarian

YesNoFormer
If you are a current or former Rotarian, please let us know what Club(s) and how long you have been or were a member.
What positions have you held within Rotary?
Headshot

Browse Files

Cancelof

Background Check
Personnal or Professional Reference
Reference Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
As an applicant for a position with Camp RYLA, I have been requested to furnish information for use in determining my qualifications. In this connection, I do hereby authorize the release and full disclosure of any
information that you may have concerning my selection with your program.

I authorize you to release information about my background including, but not limited to, information as to my employment, education, military service, driving record, criminal record and/or public records history to those
agents of Camp RYLA who require such information in order to make a decision with respect to any matter pertaining to my status as a Camp RYLA staff member.
Background Check Consent*

YesNo
Drivers License Number*
State Issued*
Are you currently under investigation for anything other than a traffic violation?*

YesNo
E-Signtature*

Clear
Name

First NameLast Name
Should be Empty:

Camp RYLA 5810