Personal

First Name:   Middle Name:   Last Name:

Street Address:   City:   State:   Zip Code:

Telephone:   Are you 18 years of age or older? Yes No

Emergency Contact (1):   Telephone:   Relationship:

Education

                                                                    Name and Address                         Last Grade Completed       Degree Earned

Primary Education (Elementary/High School:   Primary Last Grade  

Vocational/Technical:                          

College/University:                               

References:

(1) Name:   Address:

Telephone:   Occupation:   Relationship:

(2) Name:   Address:

Telephone:   Occupation:   Relationship:

Position and Pay:

Pay desired:   Date you can start (mm/dd/yy):

Skills:

Click all the boxes that apply

Tree Trimming   Stump Grinding   Chain Saw   Chipper   Bucket Truck   Shrub Trimming  Shearing

Do you have any experience in line clearance tree trimming? Yes No   If yes, how long?

Where?

Driving Skills

Do you havea valid drivers license? Yes No   State:  

Is your license a commercial drivers license (CDL)? Yes No   Is this the only license you have (or will posses)? Yes No

Driving History

Accidents
Driving positions only, do not disclose your own injuries

Date of last accident:   Nature of accident (head on, rear end, etc;):

Injuries to others? Yes No

Traffic Convictions

(Federal DOT regulations require checks on all drivers)

Other than parking violations, have you been convicted of a traffic violation in the past three years? Yes No

If you answered Yes, please explain - Enter date, the charge, the offense and the penalty

(Last Offense)              :

(Next Previous Offense):

(Next Previous Offense):

A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? Yes No

B. Has any license, permit or privilege ever been suspended or revoked? Yes No

If you answered yes to either A or B, please explain:

Ability to Perform Essential Functions of the Job

(All Production Positions) 

Are you physically able to safely perform these job duties with or without a reasonable accommodation? Yes No

Employment History

Show at least the last three years of employment

Company name:   Address:   Telephone:

From date (mm/dd/yy):   To date (mm/dd/yy):

Reason for leaving:   Name of Supervisor(s):

Company name:   Address:   Telephone:

From date (mm/dd/yy):   To date (mm/dd/yy):

Reason for leaving:   Name of Supervisor(s):

Application Verification and Acknowledgement

Please Read Carefully  

I certify that the information contained in this application is correct to the best of my knowledge and understand that falsification of this information may result in refusal to hire or, if hired, dismissal.  I authorize any of the person or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application and release all such parties from all liability for any damage that may result from furnishing such information to you.  I authorize you to request and receive such information, in the process of my being considered for employment by your company.  I agree to conform to the guidelines of the company and acknowledge that these guidelines may be changed, interpreted, withdrawn, or added to by your company’s sole option and without any prior notice to me.  I further acknowledge that my employment may be terminated, and any offer of employment, if such is made, may be withdrawn, with or without cause, and with or without any prior notice at any time, at the option of the company or myself.  I understand that no representative or employee of the company has any authority to enter into any agreement for employment for any specified period of time, or assure or make some other personnel move, either prior to or after commencement of employment or make any agreement contrary to the foregoing unless in writing signed by the president of the company.  I acknowledge that I have been advised that this application will remain for no more than 90 days from the date it was made.  I understand that any handbook or memorandum or other writing given to me shall not constitute an express or implied contract of employment.

I understand and acknowledge that any offer of employment is expressly conditioned upon my completion of a pre-employment medical questionnaire,  a review by the company’s physicians of responses to that questionnaire and any other medical records that the company may wish to obtain, satisfactory completion of any further medical examinations that may be required by the company, and a determination by the company that I am qualified to safely perform the job sought without a significant risk of future injury.  I further understand that even though this review process may take several weeks, any offer of employment remains conditional until the company's personnel officer has approved it.

Key in your full name here:   Key in today's date (mm/dd/yy):

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