Employment Application

Transcription

1 Employment Application Please Print Date Last First Middle Address (number & street) City State Zip ( ) - ( ) - Home Phone Alternative Phone (cell or message) Social Security Number Employment Desired Position Applying For: Full Time Part Time Temporary (Summer only, Weekends only, etc.) Personal Information Do you have any relatives working for Larsen s Landscaping, LLC? Yes No If yes, please state name(s) and relationship: Relationship Relationship How did you hear about the position for which you are applying? Newspaper Employment Agency Walk-In Friend/Relative Employee Referral Do you have a Driver s License? Yes No Driver s License Number State of Issue Expiration Date Operator Commercial CDL Chauffer If hired, would you have a reliable means of transportation to and from work? Yes No

2 Have you had any accidents where you were at fault during the past 5 years? Yes No If yes, please describe: Have you had any moving violations during the past 5 years? Yes No If yes, please describe: Are you at least 18 years old? Yes No If hired and under the age of 18, can you furnish a work permit? Yes No If hired, are you willing to submit to and pass a controlled substance test? Yes No If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live and work in this country? Yes No Are you able to perform the essential functions of the job for which you are applying, either with or without reasonable accommodation? Yes No (Note: We comply with ADA and consider reasonable accommodation measures that may be necessary for eligible applicants/employees to perform essential functions.) Have you ever been convicted of a crime? Yes No If yes, state the nature of the crime(s), when and where convicted. (Note: No applicant will be denied employment solely on the grounds of conviction of a criminal offense. The nature of the offense, date of the offense, the surrounding circumstances and the relevance of the offense to the position applied for may, however, be considered) Education, Training and Experience No. of years Did you Degree or completed graduate? Diploma High School Address City State Zip

3 No. of years Did you Degree or completed graduate? Diploma College or University Address City State Zip No. of years Did you Degree or completed graduate? Diploma Vocational Address City State Zip Special Skills & Qualifications: List job related licenses, skills, training, honors, awards and special accomplishments. On what date would you be available to start work? Days and hours available: (If employed, please notify your supervisor in writing, if availability should change.) Day AM PM Sunday Monday Tuesday Wednesday Thursday Friday Saturday

4 Employment History List below all present and past employment starting with your most recent employer. Account for all periods of employment. You must complete this section even if attaching a resume. of Employer of Employer

5 of Employer of Employer

6 Personal References-please list 3 personal references (not relatives, not former employers) Occupation Occupation Occupation Please read carefully and sign below- I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have personally completed this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery. I hereby authorize Larsen s Landscaping, LLC. to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and further, authorize the references I have listed to disclose to Larsen s Landscaping, LLC. any and all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure. I understand that nothing contained in this application, or conveyed during any interview, which may be granted or during my employment, if hired, is intended to create an employment contract between me and Larsen s Landscaping, LLC. In addition, I understand and agree that if I am employed, my employment is for no definite or determinable period and may be terminated at any time, with or without prior notice, at the option of either myself or Larsen s Landscaping, LLC. and that no promises or representations contrary to the foregoing are binding on Larsen s Landscaping, LLC. unless made in writing and signed by me and Larsen s Landscaping, LLC s designated representative. Applicant s Signature Date