Serving your soul through serving others

Serve to Change Your Life

Workamper Application

Enota, 1000 Highway 180, Hiawassee, GA  30546  * Web Site: www.enota.org

706-896-9966 * 800-990-8869 * Fax: 706-896-4737

Thank you in advance for filling out this form truthfully and completely.  Enota is a charitable, non-profit, service-based organization dedicated to preserving the land in a conservation effort, promoting personal and spiritual growth, providing humanitarian service and holistic education to people regardless of background, sex, race, creed or sexual orientation.            

Please send a recent picture of yourself

SUGGESTIONS FOR COMPLETING THIS FORM:
1 - Review this form and collect the information BEFORE typing
2 - Type all the way through without leaving this page
3 - Avoid pressing the "Enter" key.
     (If you do, just use the browser "Back" button and continue filling out the form.)
4 - Go down the data fields with the "Tab" button or with the mouse
5 - Go up the data fields with the "Shift" + "Tab" button or with the mouse
6 - Click the "Submit Application" button at the very bottom when you are done
7 - Wait for the Confirmation screen that the application has been received

Name:     
Address:
                        Zip Code:
Home Phone:                                 Work Phone:    
Today's date (MM/DD/YY):                 SSN:     - -
E-mail:                                        
Place of Birth:                          
Birth Date (MM/DD/YY):               Gender (M/F):
Height:        Weight: 

Driver's License Number:          State:

How did you hear about  Enota?    (please indicate the web site if from the Internet)

What is the earliest approximate date you would come to Enota?

How long a commitment are you willing to make to Enota?

When did you start workamping?

Why do you want work here?

Please describe your workamping experiences.

I have read the Policies and Operating Principles on the web page.  I have indicated below any I am not willing to abide by, otherwise I agree to abide by these policies and principles.  Please let us know anything that is unclear or you are uncertain about.

Initial here if you agree:    

 

A.   EMPLOYMENT

Recent employment history (list at least one whom we can contact)

1. Employer's Name:         Phone:
Job Description:    
Dates of job:         Reason for leaving:

2. Employer's Name:         Phone:
Job Description:    
Dates of job:         Reason for leaving:

Please list any special skills or licenses you have:

Please indicate the skills you have to contribute. We do not guarantee any position, but attempt to match your desire and skill with the needs of Enota. All of these service opportunities are available at Enota.

Housekeeping     Cook     Dishwashing     Front Desk     Cashier    
Plumber     Carpenter     Electrician     Skilled Building Contractor     Mason    
Painter     Architect     Organic Gardener     Accounting     Landscaper    
Grounds     Handyman Person     Trail Blazing     Animal Care    
Mechanical Log Splitting     Mechanic     Computer Skills     Webmaster     Grant Writer    
Writer     Promotion     Group Sales     Massage Therapist     Healer    
Yoga Instructor     Musician    

Please list in order of preference:
1.     2.     3.

Are there any specific duties in the list above that you cannot or wish not to perform?

Specify any NEED for not working weekends, some evening or early morning shifts.  If you do have a preference for working these shifts, please indicate this also.

State the maximum number of hours per week you are willing to work:     

B. PHYSICAL HEALTH
We welcome persons of varying abilities.  However, you might find some of our  service and lifestyle physically demanding.   For example, some service require heavy lifting, bending, long sitting or standing, etc.   In order that we may appropriately assign a service position for you, please answer the following:
Overall physical condition: including stamina, strength, flexibility, mobility (check one):     
Physical limitations: please indicate specifically what you can and cannot do:

Do you currently take any medications?         If yes, list medication and condition:
Medication                                                Purpose                                    Dosage              Dates of Uses


Please detail any acute or chronic health conditions (including structural problems) or any condition, which caused you to miss two or more weeks of work (or regular activity) in the last three years:

In case of emergency, please list two people for us to contact:
Name:                    Relationship:
Address:          
Home Phone:               Work Phone:

Name:                    Relationship:
Address:          
Home Phone:               Work Phone:

C. MENTAL/PSYCHOLOGICAL WELL BEING
Have you ever been diagnosed with a psychological condition?         If so, please describe the diagnosis, treatment administered and dates.

Please provide current use of any Recreational or Psychoactive Drugs and Alcohol.
I am currently using:
Type of Recreational Drug or Alcohol            Date Began               How Often          Why

Have you ever been convicted of a crime?     If yes, please explain.

Name, address and phone number of 3 people who can give a work or character reference.
(Not a friend or relative.)
Name:                   
Address:          
Phone:              

Name:                   
Address:          
Phone:              

Name:                   
Address:          
Phone:              


           To expedite this process, we ask your consent for us to contact by phone or letter any employer or reference whom you have indicated as having knowledge of your employment and/or integrity and possibly a criminal background check.   By signing below, you are giving permission to Enota to contact anyone listed in your application. (Those not to be contacted may be listed below)    Signing below also acknowledges that all the information included in this application is true and complete.   You understand that withholding information can lead to the immediate termination of your participation in programs at Enota.

            As the undersigned for and in consideration of receiving permission from Enota, 1000 Hwy 180, Hiawassee, GA 30546 to use its facilities and be on its grounds, I do hereby release and forever discharge Enota, and all of its entities, affiliates and sister organizations together with their officers, directors, trustees, members and staff from any and all liability, claims, demands, actions or causes of action whatsoever, rising out of or related to any injury, illness, loss or damage, including death, relating to or connected with my being activity at Enota, using trails or equipment on Enota property and while at Enota.  I agree to be responsible for all my health care costs and medical bills.  

  
Signed                                                                      Date

 

STATEMENT OF CONFIDENTIALITY:  All the information provided to Enota will remain confidential and not be released to any outside organization or agency.  

 

Additional Agreements (Please Initial):