PO Box 326 · Prospect, OR 97536

Employment Application

PLEASE READ INSTRUCTIONS HERE BEFORE SUBMITTING
First name:*	M.I.:
Last Name:*
Email Address:*
Primary Phone:*
Cell Phone:
Message Phone:
Address:*
City:*
State:*	Zip:*
Number of Pets:	Breed(s):
Year of RV:
Model:	# Slides:
Have you ever been convicted of a crime or entered a plea of nolo contendere? (Minor traffic violations resulting in a fine of $299 or less do not need to be disclosed.)
	No Yes
	If yes to the previous, please describe:
	Have you ever been refused bonding? No Yes
	If yes to the previous, please describe:
Are you able to perform the essential tasks and duties of the position you are applying for?
	Yes No
Please describe any duties or tasks which may not be performed on a daily basis:

Employment History
First Employer Company:*
Phone:*
Address:*
City:*	State:* Zip:*
Dates From/To:*
Start Pay:*
End Pay:*

Second Employer Company:*
Phone:*
Address:*
City:*	State:* Zip:*
Dates From/To:*
Start Pay:*
End Pay:*

Third Employer Company:*
Phone:*
Address:*
City:*	State:* Zip:*
Dates From/To:*
Start Pay:*
End Pay:*

Professional References Only
First Reference Name:*
Phone:*
Address:*
City:*	State:* Zip:*
Occupation:*
Relationship:*

Second Reference Name:*
Phone:*
Address:*
City:*	State:* Zip:*
Occupation:*
Relationship:*

Third Reference Name:*
Phone:*
Address:*
City:*	State:* Zip:*
Occupation:*
Relationship:*

Please give a brief explanation of the reason you would like to be a campground host for Rogue Recreation.

IMPORTANT: PLEASE READ THE TERMS OF SUBMISSION OF THIS APPLICATION HERE
I hereby certify I have not knowingly withheld any information which might adversely affect my chances for employment and the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand any omission or misstatement of material fact on this application or any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. I hereby authorize Rogue Recreation to thoroughly investigate my references, work record, and other matters related to my suitability for employment and, further, authorize my former employers to disclose to the company any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. I understand nothing contained in the application or conveyed during any interview which may be granted is intended to create an employment contract between me and the company. In addition, I understand and agree if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or the company, and that no promises or representations contrary to the foregoing are binding on the company unless made in writing and signed by me and the company's designated representative. Rogue Recreation is an equal opportunity provider and employer Mailing Address: PO. Box 326; Prospect, OR 97536 (541) 560-3900 Fax 560-3901
I have read and understand the Terms of Service and that submission of this form is the equivalent of an electronic signature.