570.424.9434 | info@strausernature.com
Strauser Nature's Helpers
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Winter Contractor Application
Use this form to submit an employment application to our staff.
General
First Name:
Last Name:
Email Address:
Home Phone Number:
Work Phone Number:
Cell Phone Number:
Pager Number:
Company:
Address:
City:
State:
Zip Code:
Insurance
Insurance Company:
Insurance Company Phone Number:
Insurance Broker:
Insurance Broker Phone Number:
Insurance Policy Number:
Insurance Policy Coverage Limit:
Insurance Policy Expiry Date:
Insurance WSIB Account Number:
First Vehicle / Equipment
Year:
Make:
Model:
Plow Make:
Plow Type:
Plow Size:
Second Vehicle / Equipment
Year:
Make:
Model:
Plow Make:
Plow Type:
Plow Size:
Third Vehicle / Equipment
Year:
Make:
Model:
Plow Make:
Plow Type:
Plow Size:
Fourth Vehicle / Equipment
Year:
Make:
Model:
Plow Make:
Plow Type:
Plow Size:
By clicking submit, I hereby certify that I have completed the application form accurately and have read the above stated policy, and agree to adhere to the terms and conditions as stated.
You can also email us at
info@strausernature.com
