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Barberton Tree Service: Application For Employment

Name: *

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Middle

Last

Social Security Number: *

Home Address: Street Address, City, State, Zip, Apt. No. *

Phone Number:

Cell Phone Number: *

Are you at least 18 years of age? *

Do you have a valid driver's license? If yes, please complete the next two fields. *

Driver's License Number:

Driver's License Class:

Have you had any DUI's in the past five years? If answering yes, please exaplain in the next field. *

Are you a citizen of the United States? If answering no, please explain in the next field. *

Have you ever been convicted of a felony? If answering yes, please explain in the next field. *

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Are you employed? *

May we fully inquire your background? *

Have you previously applied to or been employed by Barberton Tree Service Inc or Mulch Maker's of Ohio? *

If you answered yes to the previous field, when did you apply or were employed?

Desired Start Date: 00/00/0000 *

Desired Salary / Hourly Rate? *

How much would you like to be paid?

List all licenses held: *

High School Attended, Location, Years Attended, Graduated? *

College Attended, Location, Years Attended, Graduated?

Trade School Attended, Location, Years Attended, Graduated?

Military Service: Branch, Beginning Date (00/00/0000), Ending Date (00/00/0000).

Honorable Discharge?

Specialized Military Training?

Name of employer:

Is this your current employer?

Phone Number:

Employer Address: Street Address, City, State, Zip.

Starting Date (00/00/0000) Ending Date (00/00/0000):

Job Title:

Hourly Rate:

Salary:

May we contact them?

Name of supervisor:

Supervisor's Phone Number:

Responsibilities:

Name of former employer:

Phone Number:

Employer Address: Street Address, City, State, Zip.

Starting Date (00/00/0000) Ending Date (00/00/0000):

Job Title:

Hourly Rate:

Salary:

May we contact them?

Name of supervisor:

Supervisor's Phone Number:

Responsibilities:

Please List Three References: (Name, Address, Phone Number, Years Acquainted): *

BARBERTON TREE SERVICE, INC. is an EQUAL OPPORTUNITY EMPLOYER In accordance with the regulations set forth in Title VI and Title VII of the Civil Rights Act of 1964, as amended, Title IX of the Educational Act of 1972, as amended, Section 504 of the Rehabilitation Act of 1973, as amended, the Age Discrimination Act of 1975, and the American Disabilities Act of 1990, Barberton Tree Service, Inc. does not discriminate on the basis of race, color, religion, national origin, sex, age or disability, in providing equal opportunity for employment. The undersigned represents to Company and does declare that all information supplied by me in this application is true and I understand that any falsification will disqualify this application and may result in dismissal if employed. I further ACKNOWLEDGE, ACCEPT and AGREE that any offer of employment extended to me is expressly conditioned upon my unconditional acceptance and agreement to abide by all company policies that are now in effect and/or which may be implemented in the future, including but not limited to random drug testing and mandatory drug testing after being involved/causing any accident or injury or damage to property and that my employment at all times shall be on an “AT-WILL” basis as defined by the laws of the State of Ohio. I also agree that any offer of employment is expressly conditioned upon me first passing: 1) a substance abuse test administered by Company and/or at a facility selected and paid for by Company and; 2) a background check, including all references and prior employers, all of which Company and its agents are hereby authorized to undertake. ACCEPTED AND AGREED TO BY: *

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