Application

Submission Date
Pirc Company Application for Employment

Pirc Company is an equal opportunity employer; our policy is to abide by all federal, state, and local laws prohibiting discrimination in employment because of race, color, sex, religion, national origin, age, disability (where the person is able to perform the essential function of the position), veteran status, citizenship status, or other prohibited reasons.
Name*

First NameLast Name
Phone*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
E-mail Address*
Last 4 Digits of your SSN*
Type of employment desired

Full-TimePart-TimeSeasonal SummerSeasonal WinterInternship
Which days are you available to work?*

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Are you a U.S. Citizen?*

YesNo
Are you legally authorized to work in the United States of America?*

YesNo
Is there an expiration date to your work authorization?*

YesNo
What date does you work authorization expire?*

MonthDayYear
Date
Do you have any requirements that insist you must start or leave at a certain time?*

Yes (If Yes, Please explain)No
Please explain your schedule*
Please include days of the week and time
Position(s) applying for

AdministrativeForemanOperatorLaborerOther
Desired Wage
Date Available for Work

MonthDayYear
If the position you are applying for requires operating a motor vehicle, do you possess a valid current drivers license*
If you are applying to be a Driver please upload a photo of your Drivers License*

Upload a File
Uploading your Drivers License authorizes Pirc Company Landscaping and/or it's insurance agency Botson Insurance Group, or it's assigns, to obtain copies of consumer reports, including a motor vehicle report, pertaining to me for employment purposes, and for use in rating and/or underwriting insurance for which the above-named employer may apply, and any renewal thereof. I understand that in obtaining such consumer reports, a consumer reporting agency may be used, and I hereby authorize such use. Cancelof
Have you ever been convicted of a crime? (Exceptions: Speeding or Parking Ticket)*
Conviction will NOT necessarily be a bar to employment. Each instance and explanation will be considered in relation to the position for which you are applying

How were you referred to us?*

Walk-InSocial MediaAdEmployeeOther
Which employee referred you?*
Do you have any of the following certifications?

ICPI - Certified Concrete Paver InstallerNALP - Landscape Industry CertifiedOH Dept. of Agriculture - Pesticide Applicator LicenseSIMA - Advanced Snow ManagerSIMA - Certified Snow ProfessionalOther
Do you know how to use any of the following software?

AccessAspireBoss LMExcelLMNOutlookPower PointQuickBooksService AutopilotTeamsTurf BooksUnilock U VisionWordOther
Please check the job tasks that you have experience

Lawn MaintenanceShrub TrimmingFertilization ApplicationFall Clean UpHardscape InstallationPlant InstallationLawn InstallationLighting InstallationIrrigation InstallationSnow Plow Commercial LotSnow Plow Residential DriveSidewalk ClearingSalt ApplicationBrine Application
Please check all the equipment you have used and know how to safely operate

Riding MowerWeedeaterBackpack BlowerHydroseederWalk Behind MowerHedge TrimmerChain SawWet SawBackpack SprayerSalt SpreaderSnow PlowZTROther
Please check the vehicles you have driven and know how to safely operate

Pick Up TruckTruck and Loaded Maintenance TrailerTruck and Loaded Construction TrailerTruck and Snow PlowDump TruckATVSkid SteerWheel LoaderOther
Employment History

Please list your most recent Employers here
Most Recent Employer
Company Name
Address
Phone
Job Title
Hourly Rate/Salary
Name of Supervisor
How to contact Supervisor
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Reason for Leaving
May we contact the employer?
Past Employers
Company Name
Address
Phone
Job Title
Hourly Rate/Salary
Name of Supervisor
How to contact Supervisor
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Reason for Leaving
May we contact the employer?
Company Name
Address
Phone
Job Title
Hourly Rate/Salary
Name of Supervisor
How to contact Supervisor
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Reason for Leaving
May we contact the employer?
Education

Please list your education history
What High School did you attend?*
Name of School
Did you graduate or obtain a GED?*

YesNo
Highest Grade Completed*

8th Grade9th Grade10th Grade11th Grade
Do you have any College or Trade school experience?

YesNo
Name of College or Trade school attended
Course of Study
Did you graduate?

YesNo
Type of Degree
References

Please list two (2) references that are familiar with your professional abilities. (Omit Relatives)
Reference 1
Name*

First NameLast Name
Phone*
Years Known*
Reference 2
Name*

First NameLast Name
Phone*
Years Known*
Additional comments you would like to share
Important conditions of employment - Please read carefully, check box, and sign before submitting
Digital Signature Please sign with Mouse or Finger*
Should be Empty:

	Offense	Where	When	Charge	Sentence
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