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CEPM Employment Applicaton
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Personal Information
You must be over 18 years of age to work in the Lawncare industry. Are you at least 18 years old?
Yes
No
Position(s) Applied for: (ie: Landscape Crew, Lawn Crew, Pesticide Applicator, Irrigation...)
Last Name:
First Name:
Middle Initial:
Street Address
City
State
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zipcode
Telephone Number
Email Address
Social Security Number
General Information
How did you hear about us?
Have you ever been employed by CEPM before?
Yes
No
Are you currently employed?
Yes
No
May we contact your current employer?
Yes
No
Date available for work?
Desired Hourly Rate
Do you have reliable transportation?
Yes
No
Do you have a valid driver's license?
Yes
No
Do you have a valid commercial driver's license?
Yes
No
Do you have a valid Pesticide A&E license?
Yes
No
Do you have an expired Pesticide A&E license?
Yes
No
High School
School Name
Location of School (City & State)
Number of Years Attended
Last Year Attended
Graduate?
Yes
No
College/ Trade
School Name
Area of study?
Location of School (City & State)
Number of Years Attended
Last Year Attended
Graduate?
Yes
No
Work Experience (please start with your present or most recent employer)
1. Employer
Supervisor
May we contact employer?
Yes
No
Job Title
Duties
Employment start date?
Employment end date?
Reason for leaving
Ending Pay / Salary
2. Employer
Supervisor
May we contact employer?
Yes
No
Job Title
Duties
Employment start date?
Employment end date?
Reason for leaving
Ending Pay / Salary
3. Employer
Supervisor
May we contact employer?
Yes
No
Job Title
Duties
Employment start date?
Employment end date?
Reason for leaving
Ending Pay / Salary
Other Qualifications or Experience
Specialized Skills (Check all that apply)
Zero-Turn Riding Mower
Commercial Walk-behind mower
Residential Push Mowers
Hedge Clippers
Power Edger
Blower
String Trimmer
Chainsaw
Skid Steer
Articulating Loader
Dump Truck
Salt Truck
Snow-Plow Truck
Bed Edger
Ditch Witch
Pesticide Tank Sprayer
Ride-On Spreaders
Back-Pack Sprayer
Others not mentioned:
Professional / Personal References
Do not include family members or past supervisors
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