Employment Application

Name*
First Last
Address*
Street Address City State ZIP Code
Email*
Home Phone*
Cell Phone*
What position are you applying for?*

Personal Information
Are you comfortable lifting 50-75 lbs regularly?*
What experience do you have with heavy equipment?*
Desired pay range:*
Minimum Pay:*
Date Available To Start?*
Days/Times Available Each Week*
List 10 actions you believe are part of the general job description you are applying for at Henderson’s*
List three things that are important to you in your work environment:*
List three characteristics that best describe you*
List Activities or Interests outside of work:*
Why do you want to work here?*

Legal
Have you ever been convicted of a felony?, If yes, list date and place.
Driver's License #*
Driver's License: State Issued*
Driver's License: Expiration Date
Do you have a CDL? If yes, what type?*
Has any license, permit or privilege ever been suspended or revoked? If yes, please explain*
Have you had a traffic accident in the past 5 years? If yes, list last date and who's fault
Traffic convictions and forfeitures for the past five years (other than parking violations).*
If yes, List location, date and charges

Emergency Contact Info
Emergency Contact: Name*
First Last
Emergency Contact: Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Emergency Contact: Phone*
Emergency Contact: Phone*

Employment History
Employer #1
Employer #1: Name*
First Last
Employer #1:Address*
Street Address Address Line 2 City State ZIP Code
Employer #1: Starting Pay*
Employer #1: Ending Pay*
Employer #1: Job Title*
Employer #1: Start Date*
Employer #1: End Date*
Employer #1: Are you still employed there?*
- Yes, Ongoing
- Resigned
- Terminated
- Temporary Position
Employer #1: Reason You Stopped Working There*
Employer #1: Your Responsibilities*
Employer #1:Supervisor's Name*
First Last
Employer #1: Supervisor's Phone
Employer#1: Can we contact this person?*
- Yes, you have my permission to call this person as a reference.
- No, I do not want you to contact this person for a reference.

Employer #2
Employer #2: Name*
First Last
Employer #2:Address*
Street Address Address Line 2 City State ZIP Code
Employer #2: Starting Pay*
Employer #2: Ending Pay*
Employer #2: Job Title*
Employer #2: Start Date*
Employer #2: End Date*
Employer #2: Are you still employed there?*
- Yes, Ongoing
- Resigned
- Terminated
- Temporary Position
Employer #2: Reason You Stopped Working There*
Employer #2: Your Responsibilities*
Employer #2:Supervisor's Name*
First Last
Employer #2: Supervisor's Phone
Employer#2: Can we contact this person?*
- Yes, you have my permission to call this person as a reference.
- No, I do not want you to contact this person for a reference.

Education
GED Name and Address*
High School: Name, Address, Year of Graduation*
College: Name, Address, Year of Graduation*
Please list any additional Classes, Workshops or Certifications that pertain to this field:*
Please list your Professional Skills relating to Arboriculture, Horticulture, Landscaping or Design:*
Please list any Professional Interests relating to Arboriculture, Horticulture, Landscaping or Design:*

Work Related References
Work Related Reference #1*
Name, Address, Phone, Company Name, Position
Work Related Reference #2*
Name, Address, Phone, Company Name, Position
Work Related Reference #3*
Name, Address, Phone, Company Name, Position
Additional Information I would like you to add about my values, desires and work ethic:*
Name, Address, Phone, Company Name, Position
The facts set forth above in my application for employment are true and complete. I understand that false statements or omission of information on this application or any other employment form may lead to dismissal or denial of employment. You are hereby authorized to make any investigation of my personal history, financial, criminal, credit and motor vehicle records through any investigative or credit agencies or bureaus of your choice. You are also authorized to administer personality profile tests and verify my back ground. A criminal record or sentience is not an automatic disqualification for employment. I agree to submit to any drug or alcohol testing prior to or after employment and I agree to submit to a medical evaluation if required. In making this application for employment, I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends or others with whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living. I understand that I have the right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of this investigative consumer report. In exchange for the consideration of my employment application by the company, I hereby release and forever discharge the company (including its directors, officers, employees and agents) and my past and/or present employers (their directors, officers, employees and agents) from any liabilities which may result from an investigation of my past and/or present employment or from the disclosure of such information. I authorize persons to answer all questions asked concerning my ability, character, reputation and previous employment record. I understand that if my application is accepted that employment with this company at all times is employment "at will”. It is further understood that this “at will” relationship may not be changed by any written document, verbal statements, or by conduct unless such change is specifically acknowledged by an authorized executive of the company. I further understand that my “at will” employment may be terminated at any time by myself or the company and includes no guarantee, contract or promise of employment for any specific length of time. I understand that the first two weeks with HTS is considered a trial period, and that my official start date will be after it is over. In the third week of work with Henderson’s Tree Service, LLC. I will have a review with the co-owners to determine any improvements to my performance deemed necessary, my rate of pay, and anything else the owners feel is pertinent to my success as an employee. I further understand that the first ninety (90) days of employment is a new hire introductory period.
Your Full Name
First Last
Drug Free Policy Agreement*
- I understand that this is a drug free work place.

Employment Application

Step 1 of 8

Personal Information

Legal

Emergency Contact Info

Employment History

Employer #1

Employer #2

Education

Work Related References