Work Camper Application

Requested Information
Name
Address
Telephone #
E-mail
Do You Have Any Pets?
If "Yes" what kind and how many?
RV Name/Length
Tentative Arrival Date
Tentative Departure Date
Describe any physical impairments you think we should be aware of:
Have you ever been convicted of a felony or incarcerated?
If "Yes" why?

Former Employer #1
Name, Address & Phone
Salary
Positions
Reason for Leaving

Former Employer #2
Name, Address & Phone
Salary
Positions
Reason for Leaving

Former Employer #3
Name, Address & Phone
Salary
Positions
Reason for Leaving

Former Education
High School Attended
Year Graduated High School
Last School Attended
Years Completed
US Military or Naval Service
Rank
Do you have any special talents and skills we should know about?

Employee Preferences
What Departments Would You Like To Work In? Choice 1
What Departments Would You Like To Work In? Choice 2
What Departments Would You Like To Work In? Choice 3
What Departments Would You Like To Work In? Choice 4
What Departments Would You Like To Work In? Choice 5
How Many Hours A Week Would You Like To Work:
Are you flexible with hours and positions to be worked?
Have you workcamped before?
Why did you choose to become a WorkCamper
Do you have any plans to travel which would require some adjustments in your Resident Staff assistance? If so what are your plans?
What would be your ideal work experience here?
Are you able to work on a roof/ladder?
Tell us about yourself....
Describe your personality and attitude:

Person To Contact In Case Of Emergecny
Name
Tel #
Address
Relationship To You / Other

Electronic Signature
Upload Resume