Field Employment Form Name* First Last Date* MM slash DD slash YYYY Address* Address* Apt# City* AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State* ZIP* Phone*Email* Are you 18 or older?* Yes Emergency Contact Emergency Contact Phone # Emergency Contact Address Are You A U.S. Citizen Or An Alien Authorized To Work In The U.S.?* Yes No If No, Please Explain EMPLOYMENT DESIREDPosition Desired* Date You Can Start* Are You Employed Now? Yes If So, May We Contact Your Present Employer? Name of Employer? Your Position And Pay Rate Why Do You Seek Employment At Peabody Landscape Group? What Is Your Desired Pay Rate? Per Hour Salary Per Week $ EDUCATIONAL BACKGROUNDHigh School University / College Area Of Study Special Subjects Or Work Experience Certifications / Licenses WORK EXPERIENCE IN THE FOLLOWING CATEGORIES Identify your experience in each category below using the following (NUMBER) (1) No Knowledge (2) Unfamiliar (3) Weak (4) Familiar (5) Little Experience (6) Good (7) Knowledgeable (8) Trained/Experienced (9) Perform Frequently (10) Expert & ProficientLandscape / Planting Installation Grounds Maintenance Carpentry Construction Lighting Installation Irrigation Install / Service Masonry Construction Concrete Placement - Finishing Plant Pruning / Shrub Trimming Zero -Turn Mower Operation Weedeater / 2-Cycle Equipment Lawn Care - Fert / Weed / Pest Pesticide Applicator License Pavers, Patios, Walks, Flagstone Tree Climbing - Pruning & Removal Cut Off Saw / Jack Hammer Tree And Shrub - Fert / Pest Bobcat - Skidloader Backhoe / Mini-Excavator Drive Pickup Truck & Trailer Bi-Lingual With Spanish Mechanical Repair Experience CDL Driver's License DRIVING INFORMATIONDo you have a valid Driver's License? Driver License # State Expiration Date # Of Points on Record Do You Currently Have Vehicle Insurance? Do You Have Reliable Transportation to and from Work? Are You Insurable for Driving? EMPLOYMENT HISTORYStart Date / End Date / Name Of Employer / Phone # / Salary/Hourly Wage / Reason For LeavingWhich Of These Jobs Did You Like Best and Why? What Did You Like Most About This Job? REFERENCES Please supply (3) Business/Work Related References and (1) Personal ReferenceName / Years Known / Relationship / Phone #OTHER BACKGROUND INFORMATIONHave You Served in the Military Yes No IF YES, What Service? Years Served Rank When Discharged Specialty Honorable Discharge Yes No If No, WHY? Do you have any allergies that will affect your working with plant material? Yes No If YES, Please explain the allergy Do you have any problem working within an American / Hispanic environment? Yes No Do you have any past legal offenses or criminal charges from which you have a criminal record? Yes No If yes, please explain. AGREEMENT OF UNDERSTANDING FOR PURPOSES OF EMPLOYMENT I certify that the facts contained in this application are true and are to the best of my knowledge. I understand that if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information the previous employer(s) may have, and release all parties from any liability for damage that may result from furnishing this information to you. I understand and agree that if hired, my employment is for no definite period and may, regardless of the date of payment of my wages and salary, be terminated at any time without prior notice and without cause. I understand that Peabody Landscape Group is an alcohol and substance free workplace and that as an employee/associate or as a contract to Peabody Landscape Group, I will be subject to alcohol and/or drug testing as required by the corporate policy. I understand and agree* Yes Additional Remarks:CAPTCHA
