Application for employment at: Page one of four

Pleasant View Construction and Landscaping LLC,

5415 Creek Rd

Millmont PA 17845

(570) 922-0562 Web: www.pleasantviewllc.com

Applicants Name ____________________________ . Date of birth _____________.

Current Address _____________________________________________________.

I (applicant) herby permit Pleasant View to do a background check on myself. I permit Pleasant view to acquire criminal records as well as driving records.

SSN is _______________________

Have you ever been convicted of any misdemeanor or Felony? --------- yes--no

If yes please explain charges and a brief summary of incident. __________________

__________________________________________________________________

Have you been in a automobile accident in the last three years? -------- yes -- no

Have you been issued any driving fines in the last three years? ----------yes --- no

If yes please explain __________________________________________________

__________________________________________________________________

Have you ever had a D.U.I. charge? --------------------------------------------yes----no

Do you have a current drivers license? -------------------------------------------yes ----no

Can you legally work within the USA?----------------------------------------yes-------no

Do you have a workers permit in USA? ------------------------------------------yes ----no

Will you be able to provide your own transportation to work -------------- yes----- no

Do you use any Illegal drugs or have you in the last 90 days -------------yes -----no

Signature _________________________________ Date ____________

Application for employment at: Page two of four

Pleasant View Construction and Landscaping LLC,

5415 Creek Rd

Millmont PA 17845

(570) 922-0562

What rate per hour would you prefer to be paid? $ ________ per hour

Pleas list at least 3 personal references and contact info below

(Please do not list family members)

#1 ___________________________ Phone number( ) ______________

How long have you known this person? ____________ How do you know this

person, or what is/was your relation with them ? _____________________________

__________________________________________________________________

#2 ___________________________ Phone number( ) ______________

How long have you known this person? ____________ How do you know this

person, or what is/was your relation with them ? _____________________________

__________________________________________________________________

#3 ___________________________ Phone number( ) ______________

How long have you known this person? ____________ How do you know this

person, or what is/was your relation with them ? _____________________________

__________________________________________________________________

Initial _________ and date________ Continue on page 3

page: three of four

(personal reference )

#4 ___________________________ Phone number( ) ______________

How long have you known this person? ____________ How do you know this

person, or what is/was your relation with them ? _____________________________

__________________________________________________________________

Now list at least three business references below

#1 ___________________________ Phone number( ) ______________

How long have you known this person? ____________ How do you know this

person, or what is/was your work relation with them ? _____________________________