PRE-EMPLOYMENT QUESTIONNAIRE
DATE:
Name: Phone Number: Address: Best time to call? City, State and Zip: Driver's License # & State: How Is Your Driving Record?
EDUCATION
Name & Location of School
Years Attended
Graduated?
Subjects Studied
Grammer School
High School
College
Trade, Business or Correspondence School
Do you have any special studies, skills, research work, and/or training that would be a valuable asset to Envirocare?
What is your primary area of interest? (Please rate using 1-5 scale with 1 meaning the Most and 5 meaning the Least)
Landscape Design/Architecture Landscape Construction Landscape Maintenance Lawn Care & Maintenance Irrigation Installation & Maintenance Tree Care & Removal
How many years of experience do you have in the Green Industry. (All may apply)
Professional Recreational & Personal Educational Other
WORK HISTORY – Most recent employment
Name, Address & Phone
Salary
Position
Reason for Leaving
From
To
SKILLS
Rate your ability to perform the following tasks, fill in A, B, C, or D for each task.
A- Above Average Ability
B- Average Ability
C- Little Ability, Need More Training
D- No Ability, Willing to Learn
Operate a zero turn riding mower
Tractor, 3 point hitch & attachments
Operate commercial 36”-52” walk behind mowing equipment
Skid loader operation & attachments
Operate gas powered hand held equipment, trimmers, blowers, edgers, etc.
Backhoe or mini excavator operator
Ability to lift 75lbs., load, transport & dump standard 6 cu. Ft. wheelbarrow loaded w/ topsoil
Load dump trucks using bucket, skid loader or pallet forks
Planting trees & shrubs by hand
Dozer operation & ability to grade site
Knowledge of pruning
Finish grading using tractor & boxblade or skid loader
Tree & shrub identification
Hydroseeding mixing tank & application
Hardscape construction; brick patios, retaining walls, decks, etc.
Fertilizer spreader, distribute even application rates
Operation of chainsaw, chainsaw maintenance & safety
Chemical spraying, eliminate weeds in turf or beds using approved herbicide
Snow plowing skills
Weed identification
Salting, snow blowers, shovels, etc.
Knowledge & proper use of herbicides & safety guidelines
Knowledge of basic irrigation construction
Basic mechanical skills
Operating a trencher / vibratory plow
Mathematical, reading, spelling skills
I certify that the above facts listed on this application are true and accurate to the best of my knowledge. I authorize Envirocare Lawn & Landscape to request my driver’s license motor vehicle report to ensure insurability as well as the investigation of all statements contained herein and the employers listed above to give any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release the company from all liability for any damages that may result from utilization of such information.
Signature: Date: Initials:
(Type your name and initial next to the date for your electronic signature.)
Driver’s License Authorization
Name:
Date of Birth:
Social Security #:
Drivers License #:
Drivers License State:
I authorize Envirocare Lawn & Landscape, Stapleton Insurance Group & their agents/representatives to request & examine my driver’s license motor vehicle report to ensure insurability for possible future employment.