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BACKCOUNTRY TRAILS
PROGRAM APPLICATION
THIS SECTION TO BE COMPLETED BY
APPLICANT
Please print neatly or type and attach blank pages if you
need more space.
To download the PDF version of application Click
here.
NAME:_________________________________________
PHONE:____________________________
BEST TIME TO CONTACT YOU:________
ADDRESS:______________________________________
| BIRTHDATE:[
year ][ month ][ day
] |
AGE: [___] |
| HEIGHT: [ feet
] [ inches ] |
WEIGHT: [ pounds
] |
SHIRT SIZE:[ x-small ] [ small ] [ medium
] [ large ] [ x-large ]
PANTS SIZE:[ waist (in.) ] [ inseam (in.)
]
BOOTS: [ size ] [ width ]
PREVIOUS CORPS EXPERIENCE
(If any):_____________________________________
AVAILABILITY DATES:__________________________
1. Why do you want to be a member of a Backcountry Trails 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
Trails 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. Please note whether you have the following special skills
or 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:
5a. Health & Physical Condition
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:
5b. Health & Physical Condition
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 |
5c. Health & Physical Condition
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:
5d. Health & Physical Condition
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:
6. 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:
7. 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 SUPERVISOR'S
(REFERENCE) EVALUATION FORM AND A COLOR PHOTOGRAPH OF
YOURSELF, MUST BE SUBMITTED TO:
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BACKCOUNTRY TRAILS PROGRAM,
-
1500 Alamar Way, Fortuna, CA. 95540
-
NO LATER
THAN 5:00 PM, MONDAY, MARCH 7, 2005 .
** Please
make sure that you have provided a reliable phone number and
the best times to reach you, so that we may schedule a phone
interview. **
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