Application Form Page

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LandServ, Inc. Application for Employment

PERSONAL INFORMATION

Name*

First Middle Last

Alternate Names, Maiden Name, Alias:

Position Applying For?*

Date Available to Start?*

Have You Ever Previously Applied for a Position at LandServ?

Yes

Permanent Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Mailing Address (if different from above):

Email Address:*

Phone Number:*

Are you at least 18 years of age?*

Do you have a reliable form of transportation to and from work?*

Do you have a valid driver's license?*

Do you have a valid commercial drivere's license (CDL)?*

Have you been convicted of a felony or misdemeanor?*

If yes, please provide explanation. Conviction is not an automatic bar to employment and each situation will be evaluated on its merits.

Are you legally eligible to work in the United States?*

EDUCATION INFORMATION

Indicate the Highest Grade/Year Completed:*

High School Diploma or GED Equivalent?*

Name & Location of High School*

Business/Trade

Name & Location

# of Years

Major/Field

Did you graduate?

College/University

Name & Location

# of Years

Major/Field

Did you graduate?

EMPLOYMENT HISTORY

(Please list jobs that have related skills for the position for which you are applying. List most recent FIRST)

Most Recent Employer/Company

Employer/Company:

Employer/Company Address:

Position Title/Duties & Skills:

Supervisor Name:

Reason for Leaving:

Rate of Pay Upon Leaving:

Dates Employed (month/year)

From

Previous Employer/Company

Employer/Company:

Employer/Company Address:

Position Title/Duties & Skills:

Supervisor Name:

Reason for Leaving:

Rate of Pay Upon Leaving:

Dates Employed (month/year)

From

Previous Employer/Company

Employer/Company:

Employer/Company Address:

Position Title/Duties & Skills:

Supervisor Name:

Reason for Leaving:

Rate of Pay Upon Leaving:

Dates Employed (month/year)

From

ADDITIONAL INFORMATION

Please write a brief description of why you think you would be a good candidate for the position.

Describe any training, experience, of skills that pertain to the position for which you are applying:

References (Please do not list family members):

Reference #1*

Name:

Title:

Company:

Phone Number:

Reference #2*

Name:

Title:

Company:

Phone Number:

Reference #3*

Name:

Title:

Company:

Phone Number:

Resume Upload

Accepted file types: pdf, Max. file size: 8 MB.

The essential functions of most jobs at LandServ will require that employees lift up to 50 pounds frequently, bend and stoop frequently, push carts frequently, stand and/or walk long periods of time, some climbing, and work in extreme weather conditions.

In the event that these functions may be applicable to the position for which you are applying, can you perform all of the above functions or perform all of the above functions with reasonable accommodation?

*Answering “No” to this inquiry is not an automatic bar to employment.

Yes/No*

LandServ is an equal opportunity employer.

Employment at LandServ is on an at-will basis unless otherwise stated in a written individual employment agreement signed by an Officer of the Company. This means that either the employee or the Company may terminate the employment relationship at any time, for any reason, with or without notice.

Signature of Applicant:*

Date*

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