EMPLOYMENT APPLICATION

SIERRA PINES CAMP

PO Box 70

Twin Bridges, CA 95735

Phone: (530) 659-7111; Fax: (530) 659-7790; info@sierrapines.org

(Please type or print) Name:

Date:

Permanent Address:

Street:

City:

State:

Zip:

Phone:

( )

Social Security No.:

Email:

If you are under 18 years of age, please state your age:

Position(s) Applying for:

Date Available to Start:

Are there any reasons you may have difficulty in performing any of the essential elements of the job for which you

have applied?

If so, please explain:

Would you be able to commute or would you require housing on the camp?

EDUCATION AND TRAINING

	# Years Completed	Name of School	Major	Degree/Certificate
1.
2.
3.

EMPLOYMENT (Past 10 years with most recent first)

Current Employer

Dates Employed:		Contact Person for Reference (specify title):

Company Name/Address/ and Phone


Supervisor Name		Nature of you work/Job Title		Reason For Leaving

Former Employer

Dates Employed:		Contact Person for Reference (specify title):

Company Name/Address/ and Phone


Supervisor Name		Nature of you work/Job Title		Reason For Leaving

Former Employer

Dates Employed:		Contact Person for Reference (specify title):

Company Name/Address/ and Phone


Supervisor Name		Nature of you work/Job Title		Reason For Leaving

Please list three personal (not related) references having knowledge of your character, experience, and ability.

	Name	How Does This Person Know You?	Phone #
1.			( )
2.			( )
3.			( )

Do you have a valid Driver’s License? Y ____ N _____ State _____

If under age 18, can you, after employment, submit a work permit? Y_____ N_____

Can you, after employment, submit verification or your legal right to work in the US? Y_____ N_____

Have you been convicted of a crime within the past 7 years? Yes _____ No _____

If yes, where? Nature of offense?

Please Explain:_________________________________________________________________________________

_____________________________________________________________________________________________

Please describe any other skills or experience that may have a bearing on the position(s)

for which you are applying. _____________________________________________________________________

_____________________________________________________________________________________________

What positive contributions can you make at Sierra Pines?______________________________________________

_____________________________________________________________________________________________

In Case of Emergency, Notify

Name: __________________________________________ Phone: (_____) _______________________________

Address: _____________________________________________________________________________________

I authorize the investigation of all statements herein and release the camp and all others from liability in connection with the same. I understand that untrue, misleading or omitted information herein may result in dismissal, regardless of the time of discovery. Employment is subject to verification that applicant meets certain legal age requirements of the position and/or to operate equipment required in the position and is legally qualified to work in the United States.

Signed: ________________________________________________________ Date: ________________________