Employment Application

Breitenbush Retreat & Conference Center
P.O. Box 578 - Detroit, OR 97342
503.854.3321

Employment Application

How did you hear about Breitenbush?

Feel free to e-mail your resume to personnel@breitenbush.com after you have completed this application form.

First Name:
Middle Name:
Last Name:
Other names you go by:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
E-mail:

PERSONAL INFORMATION:

EMPLOYMENT DESIRED:

Regular (Full-Time / Year-Round) Summer (4-6 mos.) Fill-In Temp (As needed)
Teams you are applying for in order of preference (enter numerical value):
Office/Guest Reception Kitchen Housekeeping
Maintenance Systems Construction Healing Arts (OR massage License required)
Admin Marketing/Events Guest Hosting/Security Childcare
How soon can you start?

Please list and explain detailed skills and work experience directly related to each individual team you are applying for.

What other skills do you have that you would be willing to share? (i.e. Yoga, Meditation, Singing, etc.)

List your certifications and degrees. (i.e. CPR, First Aid, Oregon LMT, Food Handlers, B.A., M.A. etc.)

EMPLOYMENT HISTORY:

From:	To:	Employer Name:	Phone:	Email Address:	Supervisor:	Position & Duties:	Reason for leaving:

We prefer email addresses to telephone numbers.
May we contact your previous employers? Yes No
If applying for a regular position, will there be any family, partner or pets that will live with you? (Dogs are not allowed because we are a wildlife sanctuary and the number of cats on property is limited.)
Will they live with you Full-time or Part-Time? Full-time Part-time
What do you consider to be your strong points that qualify you for this work?
Describe your ideas and/or experience related to Intentional Community and/or Cooperative living.

Name	Phone	Email Address:	Relationship	Years known

We prefer email addresses to telephone numbers.

PERSONAL REFERENCES:

Have you ever been convicted of a misdemeanor or felony? Yes No If yes, please explain.
Will visa or immigration status prevent lawful employment? Yes No (Documentation proving legal right to work in the United States will be required upon hiring)
Is there anything that will interfere with your ability to perform, on a regular basis, the essential duties of the job you are applying for? Yes No If yes, please explain.

I certify all statements to be true and correct and authorize the investigation of information contained in this application. I understand that misrepresentation or omission of facts called for is cause for dismissal. I authorize Breitenbush Hot Springs to conduct a Criminal Background Check on the information provided in this application. Affixing my name to this electronic form is considered my legal signature.

Applicant Signature

Date

Breitenbush Hot Springs is an equal opportunity employer and does not discriminate on the basis of race, sex, age, color, religion, national origin, marital status, veteran status or any other basis prohibited by federal, state ot local law.