Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Main Phone *

(###)

###

####

Alternate Phone

(###)

###

####

Do you have a current Red Cross (or equivalent) Lifeguard Certification?

Yes

No

CPR?

Yes

No

Wilderness First Aid?

Yes

No

EMT?

Yes

No

RN/LPN?

Yes

No

Do you have a valid driver's license? *

Yes

No

Primary subject knowledge *

In the following list, please check each box before those subjects you full command of.

Archaeology

Ornithology

Ichthyology

Aquatic Macroinvertebrates

Botany

Herpetology

Entomology

Mycology

Cultural History

Wild Harvesting

Astronomy

Art

Natural History

Geology

Photography

Other

NOTE *

By submitting this application, you are indicating that you are willing to submit to a criminal background and sex offender registry check prior to beginning your employment. You may be asked to provide further identifying information and personal references as part of this process. If you understand and agree to the above statement, please check this box:

I agree