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EMPLOYMENT APPLICATION & PERSONNEL RECORD FORM
Ability to perform essential functions of the job (all positions): All production positions are physically demanding. Entry-level employees in these positions are expected, within a reasonable time after they commence employment, to be able to do tree work. This work includes climbing trees and removing tree limbs using various hand and power tools on a continuous basis during an eight to ten hour shift; removing and disposing of tree limbs using various mechanized tools, which can require lifting and carrying from 50 to 100 pound loads. Most entry level employees may also be required to obtain state licenses to apply pesticides and engage in duties that require exposure to various chemicals and pesticides.
Please Read Carefully
Application Verification and Acknowledgement
I certify that the information contained in the application is correct to the best of my knowledge and understand that falsification of this information may result in refusal to hire or, if hired, dismissal. I authorize any of the persons or organizations referenced in this application to give you any and all information concerning my previous employment, education, or any other information they might have, personal or otherwise, with regard to any of the subjects covered by this application and release all such parties from all liability for any damage that may result from furnishing such information to you. I authorize you to request and receive such information, in the process of my being considered for employment by your company. I agree to conform to the guidelines of the company and acknowledge that these guidelines may be changed, interpreted, withdrawn, or added to by your company's sole option and without any prior notice to me. I further acknowledge that my employment may be terminated, and any offer of employment, if such is made, may be withdrawn, with or without cause, and with or without any prior notice at any time, at the option of the company or myself. I understand that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or assure or make some other personnel move, either prior to or after commencement of employment or make any agreement contrary to the foregoing unless in writing, signed by the president of the company. I acknowledge that I have been advised that this application will remain for no more than 90 days from the date it was made. I understand that any handbook or memorandum or other writing given to me shall not constitute express or implied contract of employment.
I understand and acknowledge that any offer of employment is expressly conditioned upon my completion of a pre-employment medical questionnaire, a review by the company's physicians of responses to that questionnaire and any other medical records that the company may wish to obtain, satisfactory completion of any medical examinations that may be required by the company, and a determination by the company that I am qualified to safely perform the job sought without a significant risk of future injury. I further understand that even though this review process may take several weeks, any offer of employment remains conditional until it has been approved by the company's personnel officer.
Upon acceptance of employment at Buckley Tree Service, Inc., I understand that I will be required to take a drug/alcohol screening within the first week of employment.
The undersigned does hereby authorize the release and delivery of all motor vehicle driving records relating to the undersigned, including but not limited to personal information, to my employer and its insurance agent, whose names and addresses are as follows:
Name and Address of Employer:
Buckley "The Tree Care Specialists"
1700 S Johnson Road
New Berlin, WI 53146
Name and Address of Insurance Agent:
American Advantage Insurance Group
2311 W Silvernail Rd
Pewaukee, WI 53072
This authorization shall continue in effect until revoked by the undersigned in a subsequent writing delivered to you.
(Complete only if you are currently a CDL Driver)
Human Resources Department
Buckley Tree Service – CDL Release Form
Release and Documentation from Previous DOT Employer
Federal Department of transportation (DOT) regulations (49CFR 10.25) require that a check be made of all potential covered service employees previously employed by DOT regulated employers to determine if there are any positive results for drugs of alcohol or other violations of DOT agency drug or alcohol testing regulations and if DOT return to duty requirements were completed. Failure to provide this written consent will prevent you from performing safety sensitive functions and may eliminate you as an employee.
AUTHORIZATION BY APPLICANT TO RELEASE INFORMATION:
To release to:
Buckley Tree Service, Inc.
1700 S Johnson Rd
New Berlin, WI 53045
Any positive controlled substance test results, alcohol test with a result of .04 percent or greater, evidence of refusal to be tested, evidence of any other violations of DOT alcohol rule violations; SAP professional evaluation; determination of DOT agency drug and alcohol testing regulations to be released immediately.
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