Main Apprenticeship Application Form

Apprenticeship Application Form

Welcome to Garden Harvest’s Education Program

Garden Harvest, Inc. - 14045 Mantua Mill Road - Glyndon, MD 21070
Phone: 410.526.0698 - Fax: 410.429.3946 - E-Mail: garharvest@.com

Name:

Home Phone: Birth Date:

Social Security Number:

Present Address:

In Case of Emergency, Please Notify:
Phone:

Drivers License No.: State:
Class: Expires:

Has Your License Ever Been Suspended or Revoked in Any State?
Yes No
If Yes, indicate which state, date, and reason:
State: Date:
Reason:

Do you own your own transportation?	Do you own your own home?	Do you regularly exercise?
Yes No	Yes No	Yes No

Are you capable of hard physical labor?	Are you a vegetarian?	Are you active in preserving the environment?
Yes No	Yes No	Yes No

Do you smoke?	Are you allergic to bee stings?	Are you allergic to poison ivy?
Yes No	Yes No	Yes No

Are you allergic to pollen?	Physician
Yes No
Address:

Have you ever collected Workman's Compensation?		If so, explain:
Yes No

Were you in the armed forces?	What Branch
Yes No
Rank at discharge	Type of discharge

Dates of duty:	List of duties in the service, including special training:
From: To:

Educational Data: Did you successfully complete

Elementary School?	Junior High School?	Senior High School?
Yes No	Yes No	Yes No
Bachelor's Degree?	Master's Degree?	Doctorate?
Yes No	Yes No	Yes No
If you did not graduate from High School, have you received a State high school equivalence certificate? Yes No
Give name and location of College, University, or Professional School

Reference Data: Personal References (unrelated persons)

Name:
Occupation:
Years Known: Phone:
Address:

Name:
Occupation:
Years Known: Phone:
Address:

Societies, clubs, or affiliations:

Experience Data

Have you done farm work?	Have you ever worked for a non-profit?	Have you worked with draft animals?
Yes No	Yes No	Yes No

Have you tended livestock?	Are you skilled in sustainable agriculture?	Can you operate a back hoe?
Yes No	Yes No	Yes No

Do you have computer skills?	Have you ever used a chain saw?	Can you drive a farm tractor?
Yes No	Yes No	Yes No

Do you consider yourself a good cook?	Have you ever done fundraising?	Do you have landscaping experience?
Yes No	Yes No	Yes No

Are you comfortable supervising others?	Do you mind working alone?	Have you ever worked with bees?
Yes No	Yes No	Yes No

Do you know how to prune fruit trees?	Do you have any masonry skills?	Do you have any carpentry skills?
Yes No	Yes No	Yes No

Do you have any electrical skills?	Do you have any plumbing skills?	Can you hang dry wall?
Yes No	Yes No	Yes No

Do you have skills working with concrete?	Do you have any roofing skills?	Do you have skill laying tile?
Yes No	Yes No	Yes No

Do you have any architectural skills?	Do you have engineering skills?	Can you repair diesel machinery?
Yes No	Yes No	Yes No

Can you repair small engines?	Please list any skills not mentioned above:
Yes No

Employment History
Give employment record as completely as possible starting with your present or last employer not to exceed past 15 yrs.

Company Name:
Supervisor:
Type of Business:
Full Time       Part Time       Phone:
Date began       Date left
Salary Start       Salary Finish
Position:
Duties:
Reason for leaving:

Address:

Company Name:
Supervisor:
Type of Business:
Full Time       Part Time       Phone:
Date began       Date left
Salary Start       Salary Finish
Position:
Duties:
Reason for leaving:

Address:

JOB DESCRIPTION AND AGREEMENT

I understand that to be an intern at Garden Harvest, Inc. is to be educated and trained in farm work which includes but is not limited to: using power equipment and heavy machinery, spraying pesticides and fertilizers, building and maintaining farm buildings, performing hard and strenuous physical labor, transporting and delivering produce, running errands off the property, working unusually long hours, working weekends if needed, supervising volunteers, cooking meals, office work, working with bees, digging, planting, weeding, harvesting, and performing any and all tasks associated with the running of a farm.

I understand, also, that the Garden Harvest Inc., its Executive Director, and its Farm Managers have the right to enroll, dismiss, direct, and schedule interns and that due to the nature of the work there will be days I do not work. This internship is temporary and I may be dismissed at any time.
By checking this box I agree to these terms.

AVAILABILITY

Do you have any impairment, physical, mental, or medical, which would prevent you from performing in a reasonable manner the activities involved in the internship for which you have applied?
Yes       No

Could you work Saturdays if needed?
Yes       No

Could you work Sundays if needed?
Yes       No

How soon could you report to work?

CONCLUSION

I authorize Garden Harvest, Inc. to investigate any and all statements made in this application. I also authorize my current or previous employers to verify the statements made in this application, and to provide other employment data relating to my job performance, as requested. I authorize Garden Harvest, Inc. to contact my references.

Falsification or misrepresentation of the information submitted on this application could result in the disqualification of the applicant from further consideration for enrollment, or if the applicant has been enrolled, could result in his/her discharge from enrollment.

I agree       Date:
May we contact your present employer? Yes       No