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Employment Application & Personnel Record Form: 
_______________________________________________



Position(s) Applied For: __________________      


Date of Application mm/dd/yy:  ______/_______/_______  



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 #: _____-_____-______



Birthday ___/___/_____

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: Y or N


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       

Reason for leaving: __________________________________________


Hourly Rate/S: $____________________


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      

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 _____________________________________



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 ______________________ 
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