Full Name   ____________________________________________________________________________

Email  _________________________________Phone/Day ________________Evening________________

Address_______________________________________________________________________________                               

______________________________________________________________________________________

Date of Birth   ______________________    Gender  ___________________

3. If you have previously resided at either The Salt Spring Centre or Mount Madonna Centre, please indicate
approximate dates and areas you were involved.

4. Please tell us why you are applying.

5. How would you describe yourself, i.e. qualities, strengths, how you relate to others, any issues or aspects of yourself
you are working on.

5.a) To what extent have you explored self-development or self-awareness? Please describe.

6. The Centre is run by staff and volunteers who have experience and skills in the following areas: Kitchen,
Maintenance, Housekeeping, Office, Grounds and Garden. Which areas you are best able to support? Why?

7. Some of the work/service assignments involve vigorous physical activity. Do you have any limitations
that may restrict your ability in such activities?

7.a) Some tasks require the use of machines; such as lawn mowers, weed eaters, etc.
Are you comfortable and experienced using any of the above? Please list.

7.b) Are you currently under the care of a physician or taking any regular medication?
If so, please give details.

7.c) Are you a vegetarian? Are you a non-smoker?

7.d) Do you have any food allergies?




7.e) Are you allergic to cats? (We have a cat in residence.)

8. How did you hear about the centre or this program?:
Friend/Relative _____ Yoga Teacher _____ Brochure _____ Internet _____ Our Website_____Other_____
(If you heard about us through a personal contact please provide their name.)_________________________

9. Please provide us with two work-related references.

10. Do you have any other comments you would like to add?

11. Please include a current resume with your application.

The Salt Spring Centre of Yoga
355 Blackburn Rd., Salt Spring Island, BC, Canada V8K 2B8
Phone: 250-537-2326   Fax: 250-537-2311  Email: kyss@saltspringcentre.com