Employment Application Background Your Name Middle Name Last Name Street Address City State Zip SSN# Phone Email Are you 18 years of age or older YesNo Date of Birth In an emergency event, contact: Name: Address: Phone: Education Highschool Name of School Address Last Grade Completed Degree Earned Vocation / Technical Name of School Address Last Grade Completed Degree Earned College Name of School Address Last Grade Completed Degree Earned other Name of School Address Last Grade Completed Degree Earned Employment History Company 1 Company Name Address Position Held Reason for Leaving Phone Number Date (From-To) Salary Supervisor Name Company 2 Company Name Address Position Held Reason for Leaving Phone Number Date (From-To) Salary Supervisor Name Company 3 Company Name Address Position Held Reason for Leaving Phone Number Date (From-To) Salary Supervisor Name References Reference 1 Name Address Phone Occupation Relationship Reference 2 Name Address Phone Occupation Relationship Reference 3 Name Address Phone Occupation Relationship Reference 4 Name Address Phone Occupation Relationship Experience Check all that you have experience with. Productin Skills(All Production Positions) Tree climbing NoYes Stump grinder NoYes Chain saw NoYes Spraying NoYes Chipper NoYes Bucket truck NoYes Other NoYes Do you have any other experience doing tree work? YesNo If your answer is yes, please describe any additional training, experience and the total number of years experience that you have: Are you trained in tree trimming? YesNo If your answer is yes, When? By whom? Do you have practical experience in tree trimming? YesNo If your answer is yes, How long? Where? Driving Information For Driving Positions Accident History Accident 1 Date Nature of Accident Fatalities YesNo Injuries to Others Accident 2 Date Nature of Accident Fatalities YesNo Injuries to Others Accident 3 Date Nature of Accident Fatalities YesNo Injuries to Others Driving Convictions Conviction 1 Conviction Date of Conviction Charge Penalty Conviction 2 Conviction Date of Conviction Charge Penalty Conviction 3 Conviction Date of Conviction Charge Penalty General Questions A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? YesNo B. Has any license, permit or privilege ever been suspended or revoked? YesNo C. Have you ever been convicted of a felony? YesNo If any questions A thru C above were answered Yes, please explain: D. Can you stand for long periods of time? YesNo E. Can you bend and lift without pain? YesNo F. Can you lift 100 lbs to a height of at least 4 ft.? YesNo G. Can you tolerate outdoors for long periods of time? YesNo H. Can you hear verbal instructions from a distance? YesNo I. Are you physically qualified to obtain a CDL? YesNo If any questions D thru I above were answered No, please explain: 1. Do you hold a valid driver’s license? YesNo If so, license # State Class 2. Are you able to drive a standard shift? YesNo 3. Do you have reliable transportation to and from work? YesNo 4. Position desired? 5. Salary requirements, if any? 6. How did you hear about this job? 7. Were you referred by a Bayou Tree Service employee? YesNo If so, by whom? 8. Date available to start work? 9. Activities/Hobbies? 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 be able to do tree work. This work may include climbing trees and removing tree limbs using various hand and power tools on a continuous basis during an eight to ten hour shift; removing and disposing of tree limbs using various mechanized tools, which can require lifting and carrying from 50- to 100-pound loads. Most entry-level employees may also be required to obtain state licenses to apply pesticides and engage in duties that require exposure to various chemicals and pesticides. Are you physically able to safely perform these job duties with or without a reasonable accommodation? YesNo Please Read Carefully Application Verification and Acknowledgement I certify that the information contained in the 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 persons 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 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 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 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 understand that the company will require pre-employment and random drug testing. I understand and consent to a background and motor vehicle record check. I further understand that even though this review process may take several weeks, any offer of employment remains conditional until it has been approved by the company's personnel officer. I understand NoYes Please leave this field empty.