Please type or print your answers neatly. Attach blank pages if you need more space.

NAME: _________________________________________

PHONE: _______________________ BEST TIME TO CONTACT YOU: _________

ADDRESS: _____________________________________________________

   (Street Address)

  ______________________________________________________

   (City, State, Zip Code)

BIRTHDATE: [month][day][year] ___________________ AGE: _______________

PREVIOUS CORPS EXPERIENCE (If any): __________________________________

SKILLS & CERTIFICATIONS:

[ ] Class B California Driver's License

[ ] Standard First Aid

[ ] Advanced First Aid or equivalent

[ ] CPR

[ ] Emergency Medical Technician: Certification Date: [month] [ year ]

[ ] Basic First Aid

[ ] Water Safety Instructor: Certification Date: [month] [ year ]

[ ] Chainsaw Certification

Other, please describe:

HEALTH & PHYSICAL CONDITION:

a. Please describe any serious recent illness, recurring illness, injury operation, disabilities, special medical needs, or any other condition that might be a limitation to performing physical strenuous, hazardous work far from medical service facilities:

b. Are you allergic to poison oak/ivy (an allergic reaction will affect your crew assignment but will not lessen your chance of being selected) [please check one]:

[ ] not allergic

[ ] mildly allergic

[ ] moderately allergic

[ ] severely allergic

[ ] have never been exposed to poison oak/ivy

[Health & Physical Condition continued]

c. How many days of work have you lost during the previous year due to injury or illness? (check one):  

[ 0 ] [ 1 ] [ 2 ] [ 3 ] [ 4 ] [ 5 ] [ 6 ] [ 7 ] [ 8 ] [ 9 ] [ 10+ ]

Reasons for lost work time:

d. There are no dentists in the backcountry. Please describe any dental problems which would not be taken thorough care of before the Backcountry season begins in April:

HEIGHT: [ feet ] [ inches ] _______________ WEIGHT: [ pounds ] _______________

SHIRT SIZE:[ x-small ] [ small ] [ medium ] [ large ] [ x-large ] ___________________

PANTS SIZE: [waist (in.)][inseam (in.)] _________ BOOTS:[ size ][ width ] _________

AVAILABILITY DATES: __________________________

1. Why do you want to be a member of a Backcountry Trail Crew?

2. Describe the most physically demanding work that you have done for a prolonged period of time:

3. Given that the most difficult challenge for a Backcountry Trail Crew member is working with and getting along with others, describe the most demanding social situation you have ever been in for a prolonged period of time and what personal characteristics you used to succeed in this situation.

4. Have you ever been involved in a serious disciplinary incident while employed? Describe, and explain why this behavior would or would not be a problem now:

5. Describe experiences you may have had in living, traveling, working in the outdoors (if your experiences are few, don't worry, just be prepared for days of heat, cold, rain, snow, and billions of bugs).

THIS APPLICATION, ALONG WITH YOUR SUPERVISORS (REFERENCE) EVALUATION FORM AND A COLOR PHOTOGRAPH OF YOURSELF MUST BE SUBMITTED TO: