Application for Employment

First Name

Middle Name

Last Name

Address

Home Phone

Cell Phone

City

State

Zip Code

Position Applying For

Who referred you?

Have you ever worked for this company before?

Yes

From:

To:

If yes, what was your position?

What was your rate of pay?

Are you currently employed?

Yes

If so, with whom?

In case of emergency, notify:

Emergency Phone

Relationship

Education

Name of High School

Degree or Diploma Major/Minor

Yes

Name of School: GED

Degree or Diploma Major/Minor

Yes

Name of College/University

Degree or Diploma Major/Minor

Yes

Degree

General

Are you available for work any day of the week day or night?

Yes

If no, please list availability:

(Days)

If no, please list availability: Hours

(Hours)

Are you currently attending school?

Yes

If yes, please list your class schedule:

Do you have any pre-existing conditions that could affect your ability to perform strenuous outdoor activities?

Yes

If yes please explain:

Equipment Experience

Please list any equipment you have experience maintaining:

Employment History

(Past five years)

Company Name

Dates Employed:

(From)

Dates Employed: To

(To)

Contact Person

Contact Phone

Wage

(Beginning)

Wage Ending

(Ending)

Position

Reason for Leaving

Duties

Company Name

Dates Employed:

(From)

Dates Employed: To

(To)

Contact Person

Contact Phone

Wage

(Beginning)

Wage Ending

(Ending)

Position

Reason for Leaving

Duties

Company Name

Dates Employed:

(From)

Dates Employed: To

(To)

Contact Person

Contact Phone

Wage

(Beginning)

Wage Ending

(Ending)

Position

Reason for Leaving

Duties

Volunteer or Extracurricular Activities

Organization

Contact Person

Duties

Dates Served:

(From)

Dates Served: To

(To)

Organization

Contact Person

Duties

Dates Served:

(From)

Dates Served: To

(To)

ALL APPLICANTS MUST COMPLETE (READ AND SIGN) THE FOLLOWING SECTION

I certify that I have read and understand all of this employment application. It is agreed and understood that the employer or his agents may investigate my background to ascertain any and all information of concern to my employment history. I release employers and other persons named herein from all liability for any damages on account of furnishing such information. I understand that, as an applicant for a position with Forever Green Inc. I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job for which I am applying for.

I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal.

If hired I agree to abide by all the rules and policies of Forever Green Inc.

This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.

Date

Applicant Signature

Have you ever been denied a license, permit or privilege to operate a motor vehicle?

Yes

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

Yes

Motor Vehicle Report Request

I authorize Forever Green Inc. to obtain my Motor Vehicle Record prior to hire and to check it periodically thereafter. I understand that this record may contain personal information including but not limited to child support payments, alimony payments as well as information on driver violations and accidents. I further agree to report any license suspensions, serious accidents or offenses, or any other condition to my supervisor immediately that may affect my ability to drive a company vehicle (or my own vehicle) after I am hired.

I understand Forever Green Inc. will use this information for employment purposes only and not furnish this information to a third party without my written consent. I agree to release Forever Green Inc. its employees and those who supplied you with the information from any liability for any damage which may result from furnishing the requested information or my failure to be hired for the position for which I am applying.

Applicant Signature

Your employment with our company may or may not be contingent upon us receiving a satisfactory motor vehicle report of your driving history depending on the position you are applying for. As a condition of employment, all employees must maintain a valid driver's license and be insurable by The Company’s insurance carrier. Any employee whose license is under restriction or suspension must inform his or her supervisor.

Some employees will be required to obtain an Iowa Class D Endorsement 2 (chauffeur’s) license in order to operate some of our larger vehicles. If a potential employee has a disability that prevents her or him from maintaining a license, Forever Green may grant an exception. Additionally, any employee who works in a position in which driving is not required may be granted an exception.

Employees who will be driving Forever Green vehicles may be subject to a periodic driving record background check. All employees will be required to maintain a driving status consistent with rules provided by our insurer. Failure to do so may result in employment termination due to the inability to fulfill essential job functions.