Work Exchange & Workamper

Application

Enota, 1000 Highway 180, Hiawassee, GA  30546

Web Site: www.enota.org

706-896-9966 * Fax: 706-896-4737

Thank you in advance for filling out this form truthfully and completely.  Enota is a  non-profit, service-based organization dedicated to preserving the land in a conservation effort and does not discriminate according to sex, race, creed or sexual orientation.    

 

         

Please send a recent picture of yourself
to enota@enota.org with the subject "Picture (your name)"

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:       Gender (M/F):

Place of Birth:   Birth Date (MM/DD/YY):

Height:       Weight:       US Citizen (Y/N): 

Driver's License Number:       State:

How did you hear about doing Service at 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?

Please tell us about yourself:

What would you like to contribute to Enota?

Why would you like to come to Enota?

What do you expect from Enota?

Tell us about any special circumstances (for example: dogs, children, families, elderly parents, health issues, special needs)?

 

I have read the Enota Policies and all the information on www.enota.org and reviewed www.enota.com.
By initialing below I indicate that I agree to abide by these policies and principles.

Initial here:    

If you have any doubts that you will be able to do the work assigned to you or that you may not be able to honor our policies and boundaries - Please reconsidering applying.

A.   EMPLOYMENT/EDUCATION

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:


EDUCATIONAL BACKGROUND SINCE HIGH SCHOOL
School/College                                       Dates                  Degree/Diploma


Please list any special skills or licenses you have:

Please indicate the skills you have experience in and would like to contribute. 

Housekeeping    Cook     Dishwashing     Front Desk  Grounds  

Plumber     Carpenter     Electrician    Skilled Building Contractor  

Mason   Painter     Accounting     Organic Gardener   Landscaper    

Building     Alternative Energy Technician  Farmer    Laundry

Marketing    Animal Care   Log Splitting   Mechanic   

Computer Skills   Webmaster    Grant Writer    Writer   Promotion 

Group Sales     Massage Therapist   Management   Yoga Instructor       

Please list in order of skills and willingness:
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, our service (work) and lifestyles are 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

How much and how often do you smoke?

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:              

E.   COMMITMENT & HOUSING

Term Commitment Choices:  

Housing Choices:  

 

Additional Benefits

           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 background check (In connection with a possible background check, I the undersigned, releases and holds harmless Information on Demand Inc and its agents and representatives, and all entities and individuals involved in reporting information about the undersigned, from any and all claims by, or liability to, the undersigned that may result from, arise out of, or in connection with the 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 also 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.  

 

Additional Agreements (Please Initial):