All questions must be answered. State “N/A” if question is not applicable. This is a drug free workplace.
Name, Address & Phone Number
Last Name *
First Name *
Middle Name *
Phone Number *
Street Address *
City *
State *
Zip *
Personal Information
Date of Application
What position are you applying for? * Select One Landscape Foreman Landscape Laborer Lawn Maintenance Foreman Lawn Maintenance Laborer Snow Plow Operator Snow Removal Laborer
Salary Expectation
Date Available to Start Work
Work Availability (select more than one if applicable):
Full-Time
Part-Time
Weekends
Temporary
Times available for work:
Please indicate whether “a.m.”, “p.m.”, “any”, or “N/A”:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
How did you hear about us?
Submitted an application here before? Yes No
If yes, date/location
Employed here before? Yes No
If yes, date/location
Are you employed now? Yes No
May we contact your employer? Yes No
Does your employer know of your plans to change employment? Yes No
Why do you desire to make a change?
Are you on lay off and subject to recall? Yes No
Have you ever been discharged or requested to resign from a position? Yes No
If yes, please explain:
How much time have you lost from work during the last 12 months?
Do you have steady transportation to work? Yes No
Can you travel if the job requires it? Yes No
Have you ever held a position of trust? (handling money; confidential material) Yes No
Have you ever been refused Bond? Yes No
If yes, please explain:
Are you legally eligible to work in the United States? Proof of citizenship/immigration status & identity is required upon employment. * Yes No
Have you ever been convicted of or received a sentence for a crime(s) other than a minor traffic violation? Answering "Yes" is not an automatic bar to employment. Yes No
If yes, please explain, state the date, court, and place where the offense(s) occurred:
Do you hold a valid drivers license? Yes No
If so, list the state:
Have you been convicted of any moving violation(s) in the last 3 years? Yes No
If yes, please explain:
List 3 things that are important to you in a work environment:
1.
2.
3.
List 3 characteristics that best describe you:
1.
2.
3.
Why do you want to work here?
Would you be able to work on call in the winter for snow/ice removal? Yes No
Can you operate a snow plow? Yes No
Full Employment History
Must be completed even when accompanied by resume. Start with your present or last job. Include ALL assignments and positions held. Be specific about information and dates. A complete work history must be provided. All employment “gaps” must be listed.
Employer
Address (Street, City and State)
Job Title
Supervisor
From
To
Starting
Final
Resigned or Terminated? Select One: Resigned Terminated
State Reason:
Summary of work performed & job responsibilities:
Employer
Address (Street, City and State)
Job Title
Supervisor
From
To
Starting
Final
Resigned or Terminated? Select One: Resigned Terminated
State Reason:
Summary of work performed & job responsibilities:
Employer
Address (Street, City and State)
Job Title
Supervisor
From
To
Starting
Final
Resigned or Terminated? Select One: Resigned Terminated
State Reason:
Summary of work performed & job responsibilities:
Special Skills & Qualifications
Summarize special skills and qualifications from employment:
List professional, trade, business or civic activities & office held:
Computer skills (list programs and proficiency level):
WPM:
Shorthand WPM:
List any and all foreign languages you speak, read and/or write:
Schooling
Years complete
Degree Received & Major Subject
Name of School
Location
Did you graduate? Yes No
Years complete
Degree Received & Major Subject
Name of School
Location
Did you graduate? Yes No
Years complete
Degree Received & Major Subject
Name of School
Location
Did you graduate? Yes No
Trade, Business, or Correspondence
Years complete
Degree Received & Major Subject
Name of School
Location
Did you graduate? Yes No
Honors Received
Military Service
Service and Serial Number
Present Selective Service Classification
Rank at Discharge
List Duties/Special Training
Agreement
The facts set forth above in my application for employment are true and complete. I understand that false statements or omissions of information on this application or any other employment form may lead to dismissal or denial of employment. You are hereby authorized to make any investigation of my personal history, financial, criminal, credit and motor vehicle records through any investigative or credit agencies or bureaus of your choice. You are also authorized to administer personality profile tests and verify my background. A criminal record or sentence is not an automatic disqualification for employment. I agree to submit to any drug or alcohol testing prior to or after employment and I agree to submit a medical evaluation, if required.
In making this application for employment, I also understand that an investigative consumer report may be made whereby information is obtained through personal interviews with my neighbors, friends or others with whom I am acquainted. This inquiry includes information as to my character, general reputation, personal characteristics and mode of living. I understand that I have either right to make a written request within a reasonable period of time to receive additional, detailed information about the nature and scope of this investigative consumer report. In exchange for the consideration of my employment application by this company, I hereby release and forever discharge the company (including its directors, officers, employees and agents) and my past and/or present employers (their directors, officers, employees and agents) from any liabilities which may result from an investigation of my past and/or present employment or from the disclosure of such information. I authorize the use of any information in this application to verify my statements, and i authorize the past employer, doctors, all references and any other person to answer all questions asked concerning my ability, character, reputation and previous employment record.
I understand that if my application is accepted that employment with this company at all times is employment “at will.” It is further understood that this “at will” relationship may not be changed by any written document, verbal statements, or by conduct unless such change is specifically acknowledged by an authorized executive of the company. I further understand that my “at will” employment may be terminated at any time by myself or the company and includes no guarantee, contract or promise of employment for any specific length of time. I understand that the first ninety (90) days of employment is a new hire introductory period.
Electronic Signature (First and Last Name) *
Today’s Date: *
1 + 0 = ? Please prove that you are human by solving the equation *
