Apprentice Application 2011
426 Jerry Ln. NE.
Check, Va. 24072
Phone (540) 651-3228
NAME:
______________________________________
YOUR AGE: ______________________
ADDRESS:___________________________________
PHONE #:________________________
_____________________________________________
DATE OF BIRTH: _________________
EMAIL ADDRESS PLEASE PRINT:__________________________________________
ARE YOU A SMOKER, tobacco, herbal cigarettes, etc :_______
MALE __ / FEMALE __
DO YOU DRIVE A STICK SHIFT:
_________________________________________________________
AT PRESENT OR IN THE PAST HAVE YOU EVER HAD ANY SERIOUS BACK, KNEE
OR OTHER HEALTH PROBLEMS WE SHOULD KNOW ABOUT:
_______________________________________________________________________________________
IN CASE OF EMERGENCY WHO WOULD YOU LIKE US TO CONTACT:
NAME: __________________________ HOME PHONE #: _________________
RELATIONSHIP:__________________ WORK PHONE #: _________________
ADDRESS: ________________________________________________________
WHAT TYPE OF EXPERIENCES DO YOU HAVE WORKING IN THIS OR OTHER RELATED
FIELDS:
________________________________________________________________________________________
YOU LEARN DURING THIS PROGRAM. EXAMPLE: THE TYPES OF WORK YOU HOPE TO
PERFORM IN THE FUTURE USING THIS KNOWLEDGE OR THE TYPES OF THINGS YOU
HOPE TO TEACH AND SHARE.
_______________________________________________________________________________________
WHAT ARE YOUR INTERESTS IN THIS OR RELATED FIELDS:
_______________________________________________________________________________________
_______________________________________________________________________________________
ARE YOU PHYSICALLY FIT, HOW DO YOU STAY IN
SHAPE:________________________________
_______________________________________________________________________________________
ARE YOU INTERESTED/CONFIDENT/ OR WILLING TO LEARN THE USE OF SOME POWER
EQUIPMENT
ON THE FARM, SUCH AS WEEDEATER, CHAIN SAW,
TRACTOR:___________________________
______________________________________________________________________________________
______________________________________________________________________________________
WHAT IS THE TIME FRAME THAT YOU ARE AVAILABLE TO WORK IN 2009?
FROM WHEN TO WHEN?
_______________________________________________________________________________________
DO YOU HAVE YOUR OWN TRANSPORTATION: (not required)
______________________________
REFERENCES
#1 NAME ___________________________________
PHONE_____________________________________
ADDRESS__________________________________
___________________________________________
EMAIL_____________________________________
TYPE OF RELATIONSHIP WITH THIS PERSON :
__________________________________________________________________________________________
TYPE OF WORK PERFORMED WITH THIS PERSON (if applicable):
__________________________________________________________________________________________
#2 NAME ___________________________________
PHONE_____________________________________
ADDRESS__________________________________
___________________________________________
EMAIL_____________________________________
TYPE OF RELATIONSHIP WITH THIS PERSON :
__________________________________________________________________________________________
__________________________________________________________________________________________
#3 NAME ___________________________________
PHONE_____________________________________
ADDRESS__________________________________
___________________________________________
EMAIL_____________________________________
TYPE OF RELATIONSHIP WITH THIS PERSON :
__________________________________________________________________________________________
TYPE OF WORK PERFORMED WITH THIS PERSON (if applicable):
__________________________________________________________________________________________
PLEASE MAY ATTACH A RESUME WITH THIS APPLICATION IF YOU LIKE.
YOUR INFORMATION IS CONFIDENTIAL WITH SEVEN SPRINGS FARM. THANKS.