Career Application Step 1 of 3 33% Name* First Middle Last Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Date of Birth MM DD YYYY Home PhoneMobile PhoneBest Time for Contact*All DayMorningAfternoonEveningEmergency Contact 1 First Last PhoneEmergency Contact 2 First Last PhoneHigh School Name Last Grade Completed Diploma/Degree Earned Vocational/Tech School Name Last Grade Completed Diploma/Degree Earned College or University Name Last Grade Completed Diploma/Degree Earned Describe any scholastic awards, apprenticeships, certifications, licenses, seminars, symposiums, or offices held:Please list any hobbies or activities you participate in:Full-time positions, please indicate a potential start date you are available to begin employment: MM DD YYYY Temporary positions, please indicate date you are available to start employment: MM DD YYYY Temporary positions, the date you would end employment: MM DD YYYY Please list starting with present or most recent period. List full-time and part-time employers, temporary work, and periods of self-employment or unemployment. Please note: It is imperative that your employment history contain correct, accurate, and complete information, including your supervisor's name and telephone number. You may submit your job resume in conjunction to this application. However, you must provide complete information and answers concerning your employment history requested within this form, if the information is not contained within your resume. Should your resume contain redundant information corresponding to the employment history section of this application, you may write, "see resume" on this application where applicable. Please indicate if you were employed under a different name. Have you ever been discharged by any employer?*YesNoIf yes, give employer name:Are you presently employed?*YesNoIf yes, may we contact your present employer?*YesNoEmployer 1 Name Address Supervisor Phone Start Date MM DD YYYY End Date MM DD YYYY Reason for LeavingDescription of DutiesEmployer 2 Name Address Supervisor Phone Employer 3 Name Address Supervisor Phone Start Date MM DD YYYY End Date MM DD YYYY Reason for LeavingDescription of DutiesStart Date MM DD YYYY End Date MM DD YYYY Reason for LeavingDescription of DutiesEmployer 4 Name Address Supervisor Phone Start Date MM DD YYYY End Date MM DD YYYY Reason for LeavingDescription of Duties Do you have a valid Pennsylvania Driver's License?*YesNoDo you have a valid driver's license from another state?*YesNoIf yes, specify state:Do you have a valid Commercial driver's license?*YesNoIf yes, specify state:CDL Information CDL Class CDL Restrictions CDL Endorsements Are you physically qualified to drive a commercial motor vehicle with reference to your vision and hearing abilities?*YesNoHave you ever been denied a state drivers license, permit, or privilege to operate a motor vehicle?*YesNoHas any state drivers license, permit or privilege to operate a motor vehicle ever been revoked?*YesNoList all motor vehicle accidents or traffic convictions (other than parking) for the past 3 yearsType of work or position you are applying for:Ability to Perform Essential Functions of the Job (All production positions). All production positions are physically demanding. Entry-level employees in these positions are expected, within a reasonable time after they commence employment, to perform tree/landscape/spray service work. This work requires employee to perform climbing and cutting tree branches, the manual lifting and carrying of 50 to 100 pound loads, the use of various hand or power tools, large tree service machinery, obtaining Commercial Driver's License, and driving of commercial duty trucks. Are you physically able to safely perform these job duties with or without reasonable accommodation?*YesNoDo you have your own daily transportation to reach any location within a 30 mile radius from the office to which you are applying?*YesNoHave you ever been convicted of any felonies or misdemeanors? If yes, please explain the offence and final disposition:*YesNoOffence and Final DispositionHeightWeightWhat is your reaction to bee stings?What is your reaction to Poison Ivy, Sumac, Oak?What is your reaction to Allergies?What is your reaction to Heights?Please list 2 professional references and 1 personal reference. (no relatives) Professional Reference 1 First Last Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneRelationshipProfessional Reference 2 First Last Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneRelationshipPersonal Reference First Last Address Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneRelationship
