APPLICATION FOR EMPLOYMENT

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1 APPLICATION FOR EMPLOYMENT PLEASE READ BEFORE CONTINUING I agree to notify and update the Sites of any changes to the information provided. I understand that: The Sites will conduct a criminal background check to verify the information provided; The decision of the Sites to accept or reject my application is final; The position is an at will temporary employment position and may be terminated at any time; This form must be completed in full for my application to be considered; and Employees must submit a copy of a state issued photo identification card and social security card and/or drivers license. By my signature below, I verify that I have read and understood the above. Further, I verify that the information I have given is true and complete. I also confirm that I have read and understood the terms and conditions and agree to be bound by them. I understand that providing false information or not updating my information as necessary will terminate my employment. Signature Date

2 Employment Terms and Conditions Your acceptance of a position of temporary employment must carry with it your understanding that the assignment is offered pending final clearances and may be terminated at any time with or without cause, or changed at any time. By accepting a position of employment, you also agree to the following Terms and Conditions. 1. I understand and agree that the EMPLOYER is relying on my promise to work as scheduled and accordingly, I must be available for my particular assignment as scheduled. I shall attend any on-the-job-training sessions as requested or required. 2. While on assignment as a temporary employee, I shall not engage in religious or political activities, or any unauthorized commercial activity. I shall abide by all other standards of conduct as outlined in policies established by the Sites. 3. I understand that there may be media coverage of certain work sites and/or facilities. I agree that I shall not grant radio, television or press interviews, or otherwise initiate or accept media contact relating in any way to the sites. 4. I acknowledge that law enforcement agencies and private investigators will perform background checks on all permanent and temporary staff members. I hereby consent to such inquiries and agree to comply with all security and access policies and practices with the Sites. I understand that access credentials are the property of the Employer of Record and I will surrender them upon demand. 5. I agree to hold in confidence any information disclosed to me concerning the business activities of the sites, and relating to any confidential or proprietary data, and agree not to divulge such information to any person or persons unless I have received written authorization from the Sites. 6. I agree not to remove any documents or materials (whether computer-generated, hard copy, audio or otherwise) from any of the offices or other locations in which the Sites conducts business without prior written consent from the Sites. I agree not to use any photographic or recording equipment within any of the offices or other locations in which the Sites conducts business, and I expressly agree that any such photographs or records, if made, may be retrieved without notice by the Sites and/or enjoined from use by the Sites.

3 Employment Terms and Conditions continued 7. I hereby assign to the Sites all right, title and interest in and to any work product developed or created by me for the Sites in connection with my services as a temporary employee. I acknowledge that this assignment further extends to any and all profits derived from the sale, use or other application of any such work product or part thereof. 8. I agree that I will not hold the Sites, its employees, agents, sponsors, donors, volunteers, or Board of Directors responsible for any injuries or losses I might incur while performing my job responsibilities. I hereby release and agree to indemnify and hold harmless the Sites, its employees, agents, sponsors, donors, volunteers, Board of Directors against any and all claims, demands, and causes of action for damages brought by me or by any party on my behalf. The release is intended to be binding on my heirs and assigns. Signature Date

4 *Note: All persons 16 and under must also complete the parental consent form Name: Last First Middle Initial Address (must be a street address, P.O. boxes will not be accepted): Full Address (please include north, south, east or west and apartment if applicable) City State Zip Code Best contact number: D.O.B.: Age: Sex: Male Female Social Security Number # Drivers License # Previous Employer (if applicable): Previous Employer address: Previous Employer phone: Have you ever been convicted of a crime court? *Note: Checking Yes will not exclude you from consideration for employment. Are there any criminal prosecutions currently pending against you? Have you volunteered or worked on outdoor projects before?

5 Describe any experience you have working with children, persons with disabilities, etc.: Describe any experience you have working with the public/customer service: In which position would you like to work? Are there any medical, physical or other concerns which would limit the type of activity you are able to perform? If yes, indicate: Please indicate your availability below: Monday a.m p.m. To a.m. p.m. Tuesday a.m p.m. To a.m. p.m. Wednesday a.m p.m. To a.m. p.m. Thursday a.m p.m. To a.m. p.m. Friday a.m p.m. To a.m. p.m. This program runs through August 31, 2014, what do you anticipate your latest available date of employment? Do you have your own mode of transportation?

6 In case of emergency, whom should we contact? Name: Phone: Relationship: Alt. contact: Phone: Relationship: All available positions will be mainly outdoors for several hours a day despite inclement weather; employees must be willing to work under adverse weather conditions. Duties will include but are not limited to: Grounds Maintenance Habitat Restoration Landscaping Trail Counting Other duties as assigned We are looking for a motivated, reliable individual with a positive attitude and good work ethic who is enthusiastic about conservation and who will be committed to helping maintain the environment. COMPLETED APPLICATION TO: or FAX COMPLETED APPLICATION TO:

7 Employment Standards Act Parental Consent Employment Form for Youth Written Consent of Parent or Guardian Date of Consent (M/D/Y): Dates of Work: From: To: CHILD INFORMATION Name (Please print in full): Date of Birth (M/D/Y): Address (Street, City): Postal Code: Phone Number (include Area Code): Alternate Phone Number: Name: Work Location: Contact Phone: Numbers: Hours: EMPLOYER INFORMATION

8 PARENT/GUARDIAN DECLARATION I child. Name (Please print in full) am the parent of this child. I am the legal guardian of this This is my written consent for my child to be employed. I have read and am familiar with the Employment Standards Act & Regulation regarding the employment of youth. I have noted the specifics of location, hours of work and type of work to be performed. Signature: Address: (If different than child s): Phone Number (If different than Child) Alternate Phone Number: This Written Consent along with proof of the child s age must be retained by the employer as part of the employment records. (Parent or guardian should retain a copy for own records).

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