EMPLOYMENT APPLICATION FOR LANG’S HORSE AND PONY FARM
Applicant’s Name__________________________________________________________
Home Phone____________________________ Cell Phone_______________________________
D.O.B._________________ Today’s Date______________________
Driver’s License Number______________________________ State Issued In_______ Exp. Date _____________
Social Security Number_______________________________
Current Mailing Address ____________________________________________________________
_________________________________________________________________________________
Permanent Address (if different from current address)______________________________________
_________________________________________________________________________________
Email_______________________________________________________
Emergency Contact________________________________ Phone Number_____________________
Relationship to you?_________________________________
List of Personal References: We will call at least two references, plus you must have one reference fill out your personal reference
form and mail it in.
Name_____________________________________________ May we contact them? Yes
No
Phone #___________________________________________
Relationship to you________________________________ For How many years?_______________
1.
2. Name______________________________________________ May we contact them? Yes
No
Phone #____________________________________________
Relationship to you________________________________ For How many years?_______________
3. Name______________________________________________ May we contact them? Yes
No
Phone #____________________________________________
Relationship to you________________________________ For How many years?_______________
Education:
High School
Attended__________________________________________________________________________
Year you graduated______________
College or Higher Education
Attended__________________________________________________________________________
Years in School_______ Have you graduated? Yes No
Field of
Study______________________________________________________________
What job are you applying for?
Mark all the jobs which you would be interested in.
Weekend Trail Guide/Riding Instructor_____
Summer Horse Camp Counselor______
Girls Camp Evening Activity Director_______
Certified Riding Instructor_______
Camp Support Staff______
Camp Cook______
Overnight Campground Counselor_____
Please indicate your availability with a check mark:
___ June 16-20
___ Aug 11 – 15
___ June 23 -27
___ Aug 18 – 22
___ June 30 –July 3 (no work on July 4th)
___ Aug 25 - 29
___ July 7 – 11
___ April – June. Part time, limited, weekend
work.
___ Summer Weekends. Saturdays and
Sundays.
___ March 31 - April 2. Spring Break Camp.
___ April 14 - 16. Spring Break Camp.
___ July 14 – 18
___ July 21 – 25
___ July 28 – Aug 1
___ Aug 4 - 8
If you have any commitments during the summer that will require you to be gone during any of the
Summer Camp Weeks, you must list the dates and reasons below. Time off will be evaluated on an
individual basis, and will be a consideration of acceptance.
Dates I request off:
Dates:
Reason for Absence:
Dates:
Reason for Absence:
Dates:
Reason for Absence:
Additional days off will require 2 weeks’ notice in writing. Subject to managers approval.
Do you have a current CPR card?
Yes
Do you have reliable transportation?
Yes
No
What about a First Aid Card?
Yes
No
No
Have you ever been convicted of a crime? Yes No If yes, please describe. (Note: a prior
conviction is not an automatic bar to employment. The camp will evaluate the type of conviction and
when it occurred before any decision is made.)
_________________________________________________________________________________
_________________________________________________________________________________
_______________________________________________________________
Have you ever had a DUI?
Yes
No
If yes, please give date __________________________
Are you willing to fill out a W.S.P. criminal background check? Yes
apply for our employment.)
No
(If no, please do not
Employment Experience
Start with your present or last job. Include any job-related military service assignments and volunteer
activities. List any other employment references on a separate sheet.
Employer Name/Business___________________________________________________________
Job Title:____________________________
Address___________________________________________________________________________
_______________________________________________________
Supervisor’s Name____________________________________________
Phone # ______________________________________ May we contact them? Yes No
Job Duties:
_________________________________________________________________________________
_________________________________________________________________________________
Hourly Rate/Salary: Start $_____________ Final $______________
Dates Employed: From _______________________ To ____________________________
Reason for Leaving:
_________________________________________________________________________________
_________________________________________________________________________________
Given the following list of ranch responsibilities, please rate each according to your experience
performing them.
1= more than 6 months experience
2= less than 6 months experience
3= no experience
_____ Waiter/ Waitress
_____ Kitchen (cooking or prep work)
_____ Gardening/Yard Work
_____ Mechanic
_____ Welding
_____ Construction and Maintenance
_____ Fencing
_____ Caring for horses and ponies
_____ Child Care
_____ Shoeing
_____ Phone/ Receptionist
_____ Western Riding
_____ Children’s Counselor
_____ Trail Guiding
_____ Horse Training
_____ Stable Work
_____ Jumping
_____ English Riding
Do you have any health issues which would make hard physical labor difficult? Yes No
If yes, please explain:
_________________________________________________________________________________
_________________________________________________________________________________
Do you have any allergies to the outdoors? Yes
Do you have any allergies to animals? Yes
No
No
When was your last Tetanus shot?________________________________
Which languages do you speak?__________________________________
What is your prior experience with working around children?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
What prior experience do you have working with horses?
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
Are you o.k. with working a variety of hours depending on the farm’s schedule? Yes No
Are you flexible in your routine? Yes No
Do you know how to groom a horse? Yes
No
Do you know how to saddle a horse in Western tack? Yes No
Do you know how to saddle a horse in English tack? Yes No
Do you know how to bridle a horse? Yes No
Do you know how to halter, lead, and tie a horse with a safety knot? Yes No
Do you know how to ride a horse at a walk, trot, and canter? Yes No
Do you feel competent teaching children and adult beginners to ride? Yes
No
State additional information you feel may be relevant to this application.
_________________________________________________________________________________
_________________________________________________________________________________
If you are applying for other positions than camp counselor, please indicate your skills related to this
job. ______________________________________________________________________________
_________________________________________________________________________________
The following list of attributes are qualities that we look for in our staff members. Please read
through the list of examples.
Cooperation: Open positive attitude and a willingness to help out on whatever project needs to be
done.
Communication: Positive, not negative, communication amongst team members, with guests, and all
others.
Commitment: A stick-to-it-ness to complete difficult tasks and not bail out in mid-project. A strong
mind set to make this camp experience as successful as we can make it.
Character: Individuals whom we can trust and count on, and whom we can be proud to have
representing our camp and staff.
WE ARE AN EQUAL OPPORTUNITY EMPLOYER.
In signing this application, I certify that all of the foregoing information is a complete and accurate
statement of the facts and I understand that if any misrepresentation, omission or falsification can be
discovered, it will constitute grounds for dismissal. I hereby authorize you to conduct any
investigation necessary concerning any part of my background related to the position I am seeking. I
release all parties from any liability with the provision and use of such information. I understand and
agree that, if employed by this organization; I will abide by its rules and regulations which I
understand are subject to change.
Please check the box if you have done the following:
Have taken time to read and consider all of the employment criteria
Have you read all camp, trail ride, and lesson information from our website, in order to get
to know Lang’s.
Are you willing to let us look at your Facebook? If so, please make sure we have access to
these sites. If you do not want to share these then please talk to Lola Lang.
Signed________________________________________________________
Date__________________________
Please mail your application and all other supporting documentation to:
Lang’s Horse and Pony Farm, PO Box 8, Mount Vernon , WA, 98273