Step 1 of 8 - Personal Information 0% Personal InformationName* First Middle Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone #Home Phone #Email Position applying for*Who referred you?Have you ever worked for this company before?*YesNoDate From* Date To* What was your position?*What was your rate of pay?*Are you currently employed?*YesNoIf yes, with whom?*In Case of Emergency NotifyPerson to Notify* First Last Phone #*Relationship* Save and Continue Later EducationHigh SchoolName of SchoolDid you Receive your Diploma? GEDName of SchoolDid you Receive your Diploma? College / UniversityName of SchoolDid you Receive your Degree?Major/Minor? Are you currently attending school?*YesNoPlease upload your class schedule Save and Continue Later Employment HistoryLast three yearsCompany 1Company NamePositionWageDate From Date To Reason for leavingContact PersonPhoneCompany 2Company NamePositionWageDate From Date To Reason for leavingContact PersonPhoneCompany 3Company NamePositionWageDate From Date To Reason for leavingContact PersonPhoneCompany 4Company NamePositionWageDate From Date To Reason for leavingContact PersonPhone Save and Continue Later Equipment ExperiencePlease select the types of equipment you have experience operating: Basic Hand Tools Backpack Blower Weed Eater Zero Turn Mower Walk Behind Mower Snow Blower Hedge Trimmer Chainsaw Pruning Saw Forklift Skidloader Garden Tractor Farm Tractor Dump Truck Sprayer Please list any equipment you have experience maintaining: Save and Continue Later Professional ReferencesProfessional Reference 1*NamePhoneRelationship Professional Reference 2*NamePhoneRelationship Professional Reference 3*NamePhoneRelationship Save and Continue Later GeneralAr you available for work any day of the week, day or night?*YesNoIf no, please list your work availability:*Equal Opportunity EmploymentIt is the policy of Quality Care, the Nature Care Company to provide equal opportunity for all employees and applicants for employment without regard to race, religion, color, gender, creed, sexual orientation, national origin, age, marital status, veteran status, disability, or any other legally protected characteristic. This policy extends to recruitment and employment, promotion, demotion, layoff, termination, rate of pay, and other forms of compensation. Save and Continue Later Driver QualificationList Drivers Licenses held in the past three years (current license must be shown)License 1StateLicense #ClassEndorsementsExp. Date License 2StateLicense #ClassEndorsementsExp. Date License 3StateLicense #ClassEndorsementsExp. Date Have you ever been denied a license, permit or privilge to operate a motor vehicle?*YesNoHas any license, permit, or privilege ever been suspended or revoked?*YesNoMotor Vehicle Report Request I authorize Quality Care, the Nature Care Company to obtain my Motor Vehicle Record prior to hire and to check it periodically thereafter. I understand that this record may contain personal information including but not limited to child support payments, alimony payments as well as information on driver violations and accidents. I further agree to report any license suspensions, serious accidents or offenses, or any other condition to my supervisor immediately that may affect my ability to drive a company vehicle (or my own vehicle) after I am hired. I understand Quality Care, the Nature Care Company will use this information for employment purposes only and not furnish this information to a third party without my written consent. I agree to release Quality Care, the Nature Care Company, its employees and those who supplied you with the information from any liability for any damage which may result from furnishing the requested information or my failure to be hired for the position for which I am applying. Type your name to authorize the Motor Vehicle Report Request as outlined above:*Type your name again to serve as your applicant signature:*Your employment with our company may or may not be contingent upon us receiving a satisfactory motor vehicle report of your driving history depending on the position you are applying for. As a condition of employment, all employees must maintain a valid driver's license and be insurable by The Company’s insurance carrier. Any employee whose license is under restriction or suspension must inform his or her supervisor. Some employees will be required to obtain an Iowa Class D Endorsement 2 (chauffeur’s) license in order to operate some of our larger vehicles. If a potential employee has a disability that prevents her or him from maintaining a license, Quality Care may grant an exception. Additionally, any employee who works in a position in which driving is not required may be granted an exception. Employees who will be driving Quality Care vehicles may be subject to a periodic driving record background check. All employees will be required to maintain a driving status consistent with rules provided by our insurer. Failure to do so may result in employment termination due to the inability to fulfill essential job functions. Save and Continue Later Sign & SubmitI certify that I have read and understand all of this employment application. It is agreed and understood that the employer or his agents may investigate my background to ascertain any and all information of concern to my employment history. I release employers and other persons named herein from all liability for any damages on account of furnishing such information. I understand that, as an applicant for a position with Quality Care, the Nature Care Company I may be asked to demonstrate that I am capable of performing tasks which are pertinent to the job for which I am applying for. I further certify that I am a genuine applicant for employment and this application is being submitted solely for the purpose of seeking employment with Quality Care, the Nature Care Company and for no other reason. I agree to furnish any additional information and complete any examinations as may be required to complete my employment file. I also understand that misrepresentation or omission of information or facts may result in my rejection or dismissal and acknowledge that said rejection or dismissal would be justified. If hired I agree to abide by all the rules and policies of Quality Care, the Nature Care Company. This certifies that this application was completed by me, and that all entries on it and information in it are true and complete to the best of my knowledge.Todays Date* Applicant Signature*Type your name to act as your official signature. Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.