Thank you for your interest in becoming a service provider for Arctic, the midwest's leading snow plowing and ice control company!

Please complete the following form or call us at (888) 2-ICE-SNO.

* indicates required field

Personal Information
Name* Social Security #
Present Address City State Zip
Permanent Address City State Zip
Email* Phone #* Referred By
Position Applying For
 Date You Can Start
 Salary Desired
Are You Employed?
Yes No  		 If so, may we inquire of your present employer?
Yes No
Ever applied to this company before?
Yes No 		Where?
 When?

FORMER EMPLOYERS (last one first) & PLOWING HISTORY
Month & Year Name of Employer Address of Employer Salary Position Reason for Leaving
From
To
From
To
From
To
From
To

REFERENCES
Name Address Business Phone # Years Known

I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that, if employed, falsified statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you 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 damage that may result from utilization of such information.

I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the foregoing, unless it is in writing and signed by an authorized company representative.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

Please initial, you will be asked to sign this authorization if you are interviewed in person.
Initials - Signature Date: