First Name

Last Name

Email Address

Phone

Street Address

City

State

Zip

Position Applying For

Date Available

Desired Pay

References (Provide 3)

Can you lift up to 50 lbs without assistance? Can you lift up to 50 lbs without assistance? Yes No

Do you have a reliable form of transportation to get to work on time? Do you have a reliable form of transportation to get to work on time? Yes No

Do you have a driver's license? Do you have a driver's license? Yes No

What is your driver's license number?

Do you have a clean driving record? Do you have a clean driving record? Yes No

Do you have at least 2 years of similar experience? Do you have at least 2 years of similar experience? Yes No

Are you legally authorized to work in the United States? Are you legally authorized to work in the United States? Yes No

Are you able to stand and walk for long periods of time during a shift? Are you able to stand and walk for long periods of time during a shift? Yes No

If asked, how would a previous co-worker describe you?

What type of equipment have you operated?

Do you think zero accidents are achievable in a work environment?

Why are you interested in this position and our company?

Please paste a copy of your current resume

I verify that I am at least 16 years of age I verify that I am at least 16 years of age Yes No

I agree to allow Mad River Mulch to use this information during the hiring process I agree to allow Mad River Mulch to use this information during the hiring process Yes No