AMERICAN SOCIETY OF EQUINE APPRAISERS
1126 Eastland Dr. N., Suite 100
P.O. Box 186
Twin Falls, ID 83303-0186
Phone: 1-800-704-7020
E-Mail: equine@equineappraiser.com
Fax: 208-733-2326
 
MEMBERSHIP APPLICATION
Equal Opportunity Policy: It is the policy of The American Society of Equine Appraisers to recruit qualified personnel without discrimination because of Race, Color, Religion, Age, Sex, National Origin, or Handicapped condition and to give no preferential treatment to any applicant.
 
1. Personal Information:
Last Name:
First Name:
Middle Name:
Address:
City:
State:
Zip:
Home Telephone:

Format: 555-555-5555
Cell Telephone:

Format: 555-555-5555

Business Telephone:

Format: 555-555-5555

Fax:

Format: 555-555-5555

Email:
 
2. Mailing Information:
Mailing Address:
Mailing City:
Mailing State:
Mailing Zip:
 
3. Driving Information:
Do you have a valid drivers license? Yes No
License Number:
License State:
Date of Birth:

Format: mm/dd/yyyy

Exp. Date:

Format: mm/dd/yyyy

 
4. Do you have any relatives associated with this society?
Yes No
If yes, please explain ---Leave Blank If None---
 
5. Do you have any physical condition which may limit your ability to perform an appraisal?
Yes No
If yes, please explain ---Leave Blank If None---
 
6. Have you ever been expelled from or given an official reprimand by a professional organization or been convicted of a felony related to business practices or ethics?
Yes .No
If yes, please explain ---Leave Blank If None---
 
7. If you have been convicted of a felony, the nature of the felony and the length of time since conviction will be important considerations. If you have been convicted of a felony, you will not be automatically disqualified, and you will be given the opportunity to explain any convictions that may adversely affect membership.
 

8. List professional organizations, special interests, or hobbies.

---Leave Blank If None---
 
9. Employment Record: Please list employment for the last 10 years, beginning with the last or present job:
Company Name:
Company Name:
Street Address:
Street Address:
City:
City:
State:
State:
Zip:
Zip:
Job Title:
Job Title:
Supervisor:
Supervisor:
Specific Duties:
Specific Duties:
Telephone Number:

Format: 555-555-5555
Telephone Number:

Format: 555-555-5555
Start Date:

Format: mm/yyyy

Start Date:

Format: mm/yyyy

End Date:

Format: mm/yyyy
End Date:

Format: mm/yyyy
Reason for Leaving:
Reason for Leaving:
       
Company Name:
Company Name:
Street Address:
Street Address:
City:
City:
State:
State:
Zip:
Zip:
Job Title:
Job Title:
Supervisor:
Supervisor:
Specific Duties:
Specific Duties:
Telephone Number:

Format: 555-555-5555
Telephone Number:

Format: 555-555-5555
Start Date:

Format: mm/yyyy

Start Date:

Format: mm/yyyy

End Date:

Format: mm/yyyy
End Date:

Format: mm/yyyy
Reason for Leaving:
Reason for Leaving:
 

10. If your Equine Experience is not shown in your employment record please include a brief explanation of your experience with horses.
---Leave Blank If None---
 
11. Schools Attended
High School:
  
Community College:
  
Name:
Name:
City:
City:
State:
State:
Last Grade Complete:
Last Grade Complete:
   
Major:
   
Degree:
       
College or University:
  
Trade School or Apprenticeship:
  
Name:
Name:
City:
City:
State:
State:
Last Grade Complete:
Last Grade Complete:
Major:
Major:
Degree:
Degree:
       
12. Personal References: Give four references, not relatives, who can vouch for your ethics, credibility and competence. (Be sure to include complete addresses, including zip code and fax number if available.)
Reference 1:
  
Reference 2:
  
Name:
Name:
Address:
Address:
City:
City:
State:
State:
Zip:
Zip:
Telephone
Number:

Format: 555-555-5555

Telephone
Number:

Format: 555-555-5555

Fax Number:

Format: 555-555-5555

Fax Number:

Format: 555-555-5555

       
Reference 3:
  
Reference 4:
  
Name:
Name:
Address:
Address:
City:
City:
State:
State:
Zip:
Zip:
Telephone
Number:

Format: 555-555-5555

Telephone
Number:

Format: 555-555-5555

Fax Number:

Format: 555-555-5555

Fax Number:

Format: 555-555-5555

       
 
       

13a. Please list the horse breeds that you have actual experience with, not just a knowledge of:

---If None...Skip Step---
1.
2.

3.

4.
5.
6.
7.
8.
 

13b. List the disciplines (Western, Pleasure, Barrel Racing, Eventing, Dressage, etc.) that you have actually participated in:

---If None...Skip Step---
1.
2.
3.
4.
5.
6.
7.
8.
 
14. Are you willing to travel?
Yes No
 
If yes, how far?
Miles
 
15. How many hours per week could you work?
Hours
 

16. Do you have any other business interests that could compliment membership in this society? If so, please explain.

---Leave Blank If None---
 
Please Read Before Submitting:

If you have any questions regarding the following statement, please ask them of a society representative before submitting.

I authorize my previous employers, (please contact the Association Headquarters if you do not want to have your current employer contacted.) schools or persons named as references to give any information regarding my employment or educational record. I agree that my previous employers shall not be held liable in any respect if a membership is not tendered, is withdrawn or my membership is terminated because of falsity of statements, answers or omissions made by me in this questionnaire. (In the event my membership with the American Society of Equine Appraisers is accepted, I will comply with all of the rules and regulations as set forth in this, or other communications distributed to all members.)

I certify that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing that would, if disclosed, affect this application unfavorably.

 

I hereby acknowledge that I have read the above statement, that I understand the same, and that I agree to abide by all codes, regulations, and requirements of the ASEA.

I hereby acknowledge that I have read the above statement, that I understand the same; and that I agree to abide by all codes, regulations and reguirements, of The ASEA.
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I Agree: Yes No