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

Which days are you available to work?

Are you a U.S. Citizen?

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

Is there an expiration date to your work authorization?

What date does you work authorization expire?

Date

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

Please explain your schedule

Please include days of the week and time

Position(s) applying for

Desired Wage

Date Available for Work

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.

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

If Yes, please list all prior convictions you have been charged with in local, state, federal, or foreign courts

Rows	Offense	Where	When	Charge	Sentence
*
*
*
*

How were you referred to us?

Which employee referred you?

Do you have any of the following certifications?

Other

Do you know how to use any of the following software?

Please check the job tasks that you have experience

Please check all the equipment you have used and know how to safely operate

Please check the vehicles you have driven and know how to safely operate

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

Date

End Date

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

Date

End Date

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

Date

End Date

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?

Highest Grade Completed

Do you have any College or Trade school experience?

Name of College or Trade school attended

Course of Study

Did you graduate?

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