The Shepherd of the Hills

EMPLOYMENT QUESTIONNAIRE
Name:
Address:
City:
State:
Zip Code:
Date of Birth:
Marital Status:
Weight:
Height:
Social Security #:
Number of children still living in the home:

JOB INFORMATION (Please indicate by checking the job desired)
	Outdoor		Indoor		No Preference
	Daytime		Night Time		No Preference
Please indicate in which departments you would like to be considered for employment.
	Gift Shop		Office		Daytime Entertainment
	Grounds Maintenance		Theater Cast		Tour Guide
	Ticket Sales & Reservations		Concessions		Jeep Transportation (Night)
	Building Maintenance		Lighting & Sound		Stables
	Brochure Delivery		Photo Shop		Advertising & Publicity
	Other

List any qualifications dealing with the public:

If you are applying to work in the theatre cast, please answer questions A and B below.
A. Experience, high school plays, college plays, community theatre, etc.

B. Can you ride a horse?
	If so, rate yourself:	Good	Fair	Poor

Have you filed an application here before?			Yes	No	If so, when?
Have you ever been employed here before?			Yes	No	If so, when?
Have you any relatives employed by this company?			Yes	No	If so, please list below:

Have you ever been convicted of a felony within the last seven years?		Yes	No
(conviction will not necessarily disqualify applicant from employment)
If yes, please explain:


Have you ever suffered an injury that required workmen's compensation?		Yes	No
If yes, please explain:

What skills or special background do you have that might be helpful in your work?

List hobbies and interests:
1.
2.
3.

EMPLOYMENT EXPERIENCE
Start with present or last job

1. Employer	Telephone	Dates Employed		Work Performed
		From	To

Address
Job Title		Hourly Rate / Salary
		Starting	Final
Supervisor:
Reason for Leaving:

2. Employer	Telephone	Dates Employed		Work Performed
		From	To

Address
Job Title		Hourly Rate / Salary
		Starting	Final
Supervisor:
Reason for Leaving:

3. Employer	Telephone	Dates Employed		Work Performed
		From	To

Address
Job Title		Hourly Rate / Salary
		Starting	Final
Supervisor:
Reason for Leaving:

Give name, address and telephone number of three references who are not related to you and are not previous employers.
1.
2.
3.

PHYSICAL RECORD
Do you have any physical limitations that preclude you from performing any work for which you are being considered?
Yes	No
If yes, please explain below:


I certify that the facts set forth in the above employment application are true and complete to the best of my knowledge. You are hereby authorized to collect and verify any information concerning my personal or work history and medical record through any investigation of bureaus of your choice except: I hereby give my permission to The Shepherd of the Hills Historical Society, Inc. it's subsidiaries, agents, successors, assigns, and clients, to use my photograph whether still, motion, or television or recordings of my voice, and my name in any lawful purpose related to the advertising and promotion of The Shepherd of the Hills and its subsidiaries. In the event of employment with The Shepherd of the Hills, I agree that any charges against me representing the fair value of costumes or any and every form of property belonging to The Shepherd of the Hills shall be satisfied by me prior to the termination of my employment. If such charges are not satisfied prior to the termination of my employment, I agree that such charges may be deducted from any moneys due me from The Shepherd of the Hills Historical Society, Inc. It is the policy of this company to keep applications on file for a period of one year. I understand if I want to be actively considered beyond that point, I will need to contact The Shepherd of the Hills Historical Society, Inc. again. This document when completed and submitted becomes the property of The Shepherd of the Hills Historical Society, Inc.

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