Employment Application & Personnel Record Form
EEO Employer

Click Here For A Printable Version of Application

Position(s) applied for:


Date of application :     -- mm/dd/yy

Please provide the following information:

First name
Last name
Middle initial
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
E-mail

Social Security #:

Are you 18 years old or older?
  Yes       No

In case of an emergency, contact:
Name 
Phone 

Education

High School:

Number of years completed:    

Did you graduate?     Yes      No

College:

Number of years completed:    

Degree Earned

Employment History

Provide the following information of your past four (4) employers,
assignments or volunteer activities, starting with the most recent.

1.

Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone

From : -- mm/dd/yy     To : -- mm/dd/yy

Position held

Immediate Supervisor and Title:

May we contact for reference:     Yes      No      Later

Reason for leaving:

Hourly Rate/Salary:    

2.

Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone

From : -- mm/dd/yy     To : -- mm/dd/yy

Position held

Immediate Supervisor and Title:

May we contact for reference:     Yes      No      Later

Reason for leaving:

Hourly Rate/Salary:    

3.

Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone

From : -- mm/dd/yy     To : -- mm/dd/yy

Position held

Immediate Supervisor and Title:

May we contact for reference:     Yes      No      Later

Reason for leaving:

Hourly Rate/Salary:    

References

Reference:

Name
Phone
Relationship

Number of years known:    

Reference:

Name
Phone
Relationship

Number of years known:    

Reference:

Name
Phone
Relationship

Number of years known:    

Administrative Office Positions:
Complete this section only if applying for administrative/office positions

Check all boxes for which you have experience:

Dictaphone    Calculator            Microfiche           

Microfilm         Data Entry           Copy Machine

Typing    WPM               

Steno    WPM   

Switchboard    Type   

Computer Skills - please list hardware and software

 Production Skills - all production positions

Irrigation     Tree Climbing            Landscaping           

Lawnmowers         Stump Grinder     Chain Saw

Spraying         Chipper     Bucket Truck

Other       

Do you have any other experience doing tree or landscape work?  If so, describe experience and total # of years

Do you hold any certification or license related to the tree or landscaping field? 

Are you trained in line clearance tree trimming?
 Yes     No

If yes, when and by whom?

Do you have practical experience in line clearance tree trimming?
 Yes     No

If yes, how long and where?

Driving Skills - Driving positions only, must be 21 years of age or older

Commercial Drivers License
 Yes     No
If yes, State and license #

Check all you have experience operating

Automatic Transmission     Two speed rear axle            Truck & Chipper           

Manual multi-speed transmission         1 ton truck     Bucket Truck    2 ton truck 

Vehicle accident record for past 3 years or more - driving positions only.  Do not disclose your own injuries

Date of last accident 

Nature of accident 

Fatalities Yes     No

Injuries to others

Date of last accident 

Nature of accident 

Fatalities Yes     No

Injuries to others

Date of last accident 

Nature of accident 

Fatalities Yes     No

Injuries to others

Traffic Convictions for past 3 years  - other than parking violations - Driving positions only

Date 

Conviction 

Charge

Penalty

Date 

Conviction 

Charge

Penalty

Date 

Conviction 

Charge

Penalty