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

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

Stump grinder

Chain saw

Spraying

Chipper

Bucket truck

Other

Do you have any other experience doing tree work? 

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? 

        If your answer is yes, When? 

        By whom? 

Do you have practical experience in tree trimming? 

        If your answer is yes, How long? 

        Where? 

Driving Information

For Driving Positions

Accident History

Accident 1

Date

Nature of Accident

Fatalities

Injuries to Others

Accident 2

Date

Nature of Accident

Fatalities

Injuries to Others

Accident 3

Date

Nature of Accident

Fatalities

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?

B. Has any license, permit or privilege ever been suspended or revoked?

C. Have you ever been convicted of a felony?

If any questions A thru C above were answered Yes, please explain:

D. Can you stand for long periods of time?

E. Can you bend and lift without pain?

F. Can you lift 100 lbs to a height of at least 4 ft.?

G. Can you tolerate outdoors for long periods of time?

H. Can you hear verbal instructions from a distance?

I. Are you physically qualified to obtain a CDL?

If any questions D thru I above were answered No, please explain:

1. Do you hold a valid driver’s license?


        If so, license # 

        State 

        Class 

2. Are you able to drive a standard shift?

3. Do you have reliable transportation to and from work?

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?

        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?

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