Intern Application

What Specific areas are you interested in ? Check as many as apply. *

What are you hoping to get out of your volunteer experience with our Farm? *

What Kind of Farm or Garden Related Literature have you read in the past six months? Check as many as apply *

Books Magazines Web Sites

If you have volunteered with any host farms in the past, please list them and tell me about your experience. * *

What other volunteer work have you been involved with? Please name the organizations. *

Have you ever sustained any physical injuries that will affect your ability to perform certain strenuous tasks? * *

Yes No

Do you have any special dietary restrictions or medical complications (e.g. food or animal allergies, etc.)? * *

Yes No

Are you currently on any medications? If yes, then provide a list. * *

Yes No

When would you like to start work and how long would you like to stay? (Please provide specific dates that reflect your needs.) * *

Please provide, below, two (2) references, preferably previous employers, who can vouch for the quality of your work, reliability, and honesty. Include the name of your reference, where you worked for them, a brief description of your job, their phone number, and a good time to reach them.

Reference #1 Reference #1 Name * First Last Business Name * Address * Line 1 Line 2 City State Zip Code Country Phone Number * - - Employed From - To, Plus any comments. about this job. * *

Reference #2 Name * First Last Business Name * Address * Line 1 Line 2 City State Zip Code Country Phone Number * - - Employed From - To, Plus any comments. about this job. * *

If convicted, fax your current legal status to 1--423-639-7616, and explain your situation. * *

Background Check Authorization By submitting this form, I am agreeing to submit to a background, and criminal check as part of this application process. I understand that the results of these checks will be held in strictest confidence.

Upon Acceptance for a stay at Mabels Boer Stables Farm, when you arrive you will provide us with copies of the following documents. Insurance Card, One Form of Photo Identification, plus one more Form of Identification. These will be checked against the original documents you carry. If you currently do not have any medical insurance, may we suggest www.nomad.com.

By Inserting Name here I understand I am authorizing all checks listed above. * *

INTERN APPLICATION

Please provide, below, two (2) references, preferably previous employers, who can vouch for the quality of your work, reliability, and honesty. Include the name of your reference, where you worked for them, a brief description of your job, their phone number, and a good time to reach them.