Landscape Maintenance - Employment Application

REFERENCES

Please list three professional references (do no list family members or friends)
Reference One
Full Name of Reference
Relationship
Company
Phone
Years Known?
Reference Two
Full Name of Reference
Relationship
Company
Phone
Years Known?
Reference Three
Full Name of Reference
Relationship
Company
Phone
Years Known?

MOTOR VEHICLE REPORT
Do you have a valid Driver's License?*

YesNo
It is understood that my job position/employment may require me to drive a company owned vehicle. I understand that the insurance company writing your automobile insurance requires a copy of my current driving record to assess my insurability. I also understand that I have the right to see a copy of my Motor Vehicle Report.

In accordance with Industry Standards, it is now required that a notice/letter is sent to the person listed below that their motor vehicle report may contain adverse information and is being sent to an employer. Therefore, an email address is requested. If you do not have an email address, then the letter will be mailed to the physical address.

By this letter, I hereby authorize the insurance company, its agent and my employer or potential employer to obtain the necessary motor vehicle records.
Do you understand the above statement?

YesNo
Drivers License Number
State where Licensed
Address where Licensed

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Date
Email
example@example.com
Signature of Employee

Clear

DISCLAIMER & SIGNATURE
If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

By signing this application, you are granting Landscape Maintenance permission to contact and check your references.
Name

First NameLast Name
Signature

Clear
Should be Empty:

INFORMATION