"*" indicates required fields

LandServ, Inc. Application for Employment

PERSONAL INFORMATION

Name*
MM slash DD slash YYYY
Permanent Address*

 

EDUCATION INFORMATION

Business/Trade
Name & Location
# of Years
Major/Field

 

College/University
Name & Location
# of Years
Major/Field

 

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
To
 

 

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
To
 

 

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
To
 

 

ADDITIONAL INFORMATION

 

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:
 

 

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.

 

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.

 

I certify that all answers given herein are true to the best of my knowledge.*
I authorize investigation of all statements contained in this application for employment, if necessary, and acknowledge the potential for a drug screening prior to employment.*

 

 

MM slash DD slash YYYY

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Office Address

LandServ, Inc.
309 N Church Street
Boalsburg, PA 16827

Call Us:

(814) 466-9095

Mailing Address

LandServ, Inc.
PO Box 787
Boalsburg, PA 16827

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