Personal Information First Name*: Middle: Last Name*:
Alternate Names, Maiden Name, Alias:
Position Applying For? Date Available to Start?
Have You Ever Previously Applied for a Position at LandServ? YesNo
Permanent Address Street Address*: Address 2: City*: State*: Zip:
Mailing Address (if different from above):
Email Address*:
Phone Number*:
Are you at least 18 years of age?*: YesNo Do you have a reliable form of transportation to and from work?*: YesNo Do you have a valid driver's license?*: YesNo Do you have a valid commercial driver's license (CDL)?*: YesNo Have you been convicted of a felony or misdemeanor?*: YesNo If yes, please provide explanation. Conviction is not an automatic bar to employment and each situation will be evaluated on its merits. Are you legally eligible to work in the United States?* YesNo
EDUCATION INFORMATION
Indicate the Highest Grade/Year Completed*: -123456789101112 High School Diploma or GED Equivalent?*: YesNo Name & Location of High School*:
Business/Trade School
Name & Location: # of Years: Major/Field: Did you graduate?: -YesNoIn Progress
College/University
EMPLOYMENT HISTORY (Please list jobs that have related skills for the position for which you are applying. List most recent FIRST)
>Most Recent Employer/Company
Employer/Company: Employer/Company Address: Position Title/Duties & Skills: Supervisor Name: Reason for Leaving: Rate of Pay Upon Leaving: Dates Employed (month/year) From: To:
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>Previous Employer/Company
ADDITIONAL INFORMATION
Please write a brief description of why you think you would be a good candidate for the position.
Describe any training, experience, of skills that pertain to the position for which you are applying:
References (Please do not list family members):
>Reference #1 Name:* Title:* Company:* Phone Number:*
>Reference #2 Name:* Title:* Company:* Phone Number:*
Reference #3 Name:* Title:* Company: Phone Number:
Resume Upload: Accepted file types: pdf, Max. file size: 5 MB.
The essential functions of most jobs at LandServ will require that employees lift up to 50 pounds frequently, bend and stoop frequently, push carts frequently, stand and/or walk long periods of time, some climbing, and work in extreme weather conditions.
In the event that these functions may be applicable to the position for which you are applying, can you perform all of the above functions or perform all of the above functions with reasonable accommodation?
*Answering “No” to this inquiry is not an automatic bar to employment. -YesNo
LandServ is an equal opportunity employer. Employment at LandServ is on an at-will basis unless otherwise stated in a written individual employment agreement signed by an Officer of the Company. This means that either the employee or the Company may terminate the employment relationship at any time, for any reason, with or without notice.
I certify that all answers given herein are true to the best of my knowledge.
I authorize investigation of all statements contained in this application for employment, if necessary, and acknowledge the potential for a drug screening prior to employment.
Signature of Applicant:*
