Application for Employment (Driver)

Applicants are considered without regard to race, creed, color, sex, age, national origin or disability.

Date*

Date

Full Name*

Phone (Cell)*

Format: (000) 000-0000.

E-Mail Address*

example@example.com

Address Starting with the current and the last 3 addresses

List the dates you lived here below

From

Date

To

Date

Next Address

List the dates you lived here below

From

Date

To

Date

Next Address

List the dates you lived here below

From

Date

To

Date

Next Address

List the dates you lived here below

From

Date

To

Date

In case of emergency, notify*

Contact Number*

Position Applying For:

Primary Language Spoken?

Have you worked for this company before?

YesNo

If yes, when

Are you a citizen of the United States?

YesNo

If No, are you authorized to work in the United States?

YesNoN/A

What type of position are you seeking?

Full-TimePart-Time

Number of year experience in the position you are applying?

Do you hold a valid pesticide applicator license?

YesNo

What days/hours are you available to work?

Do you have a valid Driver's License?

YesNo

State

Expiration Date

Date

License Type

LIST YOUR LAST 3 JOBS

Rows	COMPANY	POSITION	REASON FOR LEAVING
#1
#2
#3

What is your highest educational attainment?

Completed On

Do you have full knowledge of the Federal Motor Career Safety Regulation?

YES

DRIVING EXPERIENCE

Rows	Type of Equipment	No. of Years	States You Have Driven In

ACCIDENT RECORD LAST 3 YEARS (This information will be verified)

Rows	Date	Nature of Accident	No. of Fatalities	No. of Injures

TRAFFIC CONVICTIONS LAST 3 YEARS OTHER THAN PARKING (This information will be verified)

Rows	Date	Violation	State	Penalty

I AUTHORIZE any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they may have, personal or otherwise, with regards to any of the subjects covered by this application, and I release such parties from all liability from any damages which may result from furnishing such information to you.

I CERTIFY that the above answers are true and complete to the best of my knowledge. I authorize A2Z Venture Group, Inc dba Belmire Premier Landscape Solutions, Inc. to investigate any statement contained in this application, and to obtain a background report on me as necessary to determine my qualifications. I understand that this application is not and is not intended to be any kind of contract or agreement. In the event of employment, I understand that any false or misleading information given in my applications, correspondence, discussions or interview may result in refusal to hire or immediate termination if hired. I understand also, that I am required to abide by all rules, regulations and policies of Belmire Premier Landscape Solutions, Inc.

SIGNATURE

Application for Employment

PERSONAL INFORMATION

Legal Work Authorization Status

Driver's License Information

WORK EXPERENCE

EDUCATION