Join Our Team

Introductory Information:

Name :

Phone:

Date :

Address:

City:

State:

Zip:

Applicant Question

Type of work Desire:

Salary Desired:

Date Available:

if hired, can you provide documents required to establish your eligibility to work in the U.S? YesNo

Are you at-least 18 year of age? YesNo

If you are under 18, and it is required, can you furnish a work permit? YesNo

Do you have a valid Driver's Licence? YesNo

How were you referred C.M. Nichols Landscaping / Maine Landscape Designs?

Have you ever been convicted of, or pled guilty or no contest to, a crime rather than a minor traffic violation? YesNo

If yes, please explain in details on a seperate piece of paper include the date of final deposition of the case and the nature of the offence. This information will not necessarily disqualify you from employment but false or misleading information will. Factor such as age and the offence, seriousness and the nature of the violation, and rehabilitation will be taken into account.

Education

High school or last grade completed:

Name & Address of School:

Course of Study:

Last grade completed:

Degree/Diploma:

College or Technical school

Name & Address of School:

Course of Study:

Last Grade Completed:

Degree/Diploma :

Other Schooling or Training

Name & Address of School :

Course of Study:

Last Grade Completed:

Degree/Diploma:

Special Skills and Certifications:

Summarize any Training, skills, licences and/ or certificates that may qualify you as being able to perform job related functions in the position for which are applying:

MILITARY EXPERIENCE:

Branch of Service:

Rank/Type of Service :

Job Related Training/Experience:

RECORD OF EMPLOYMENT:

List positions starting with most recent:

Employer:

Telephone:

Address:

Position Title:

Supervisor Name/Email/Phone:

Start date:

Date Left:

Beginning Salary:

Ending Salary:

Duties:

Reason for Leaving:

Where you subject to FMCRS while working for this company: YesNo

Was your job with this company designated as a safety sensitive function subject to drug and alcohol testing requirement of 49 CFR: YesNo

Employer:

Telephone:

Address:

Position Title:

Supervisor Name/Email/Phone:

Start date:

Date Left:

Beginning Salary:

Ending Salary:

Duties:

Reason for Leaving:

Where you subject to FMCRS while working for this company: YesNo

Was your job with this company designated as a safety sensitive function subject to drug and alcohol testing requirement of 49 CFR: YesNo

Have you ever been denied a license, permit or privilege to operate a motor vehicle? YesNo

Have any license, permit or privilege even been suspended or revoked? YesNo

Please understand that information you provide regarding, current and previous employer may be used and those employer will be contacted for the purpose of investigating your safety performance history as required by 49 CFR 391.23 (d) and (E). The attached statement entitle- Due process rights (regarding information received as a result of investigations required by 49 CRF 391.23 (d) and (e) is being provided in accordance with 49 CRF 391.23 (i).

I have read, understand and agree to the attached Due Process Statement YesNo