Employment Application

First Name

Middle Name

Last Name

Phone

Address

City

State

Zip

Are you able to preform the essential job functions of the position for which you are applying with or without reasonable accommodation?

Yes No

Have you been convicted of any felonies othat than minor traffic violations during the past seven years? (A criminal record or a conviction will not automatically bar employment, but will be considered only as it reasoinably relates yo your fitnnes to perform in the position for which you are applying.)

Yes No

If Yes Explain

GENERAL INFORMATION

Are you able to perform the essential job functions of the position for which you are applying with or without reasonable accommodation?

Yes No

Have you been convicted of any felonies other than minor traffic violations during the past seven years? (A criminal record or a conviction will not automatically bar employment, but will be considered only as it reasonably relates to your fitness to perform in the position for which you are applying.)

Yes No

If yes, explain:

EDUCATION & TRAINING:

Name & Address of School Major Course studied

Circle last grade completed

Last High School Attended/Address: College or University/Address

Other School:

List any scholarships, academic honors, awards or special achievements

SKILLS

Please list any skills you have that are appropriate for the position you are applying for:

If required, will you work?

Rotating shifts

Yes No

Saturdays

Yes No

Overtime

Yes No

Sundays

Yes No

Position applying for, be specific:

Date you can start

Salary Requirements

Salary Type

Per Hour Per Month

State fully why you believe you are qualified for this position

INTERESTS / ACCOMPLISHMENTS: You may wish to list significant experience, interests & accomplishments gained while working as a volunteer or as a hobbyist that may be useful in the position (s) you are seeking. Names or organizations designating religion, race, etc. need not be mentioned.

EMPLOYMENT HISTORY

Starting with your PRESENT or MOST RECENT EMPLOYER list in consecutive order ALL EMPLOYMENT for at least the past FOUR employers. If currently employed, may we contact your employer?

Yes No

PRESENT OR MOST RECENT EMPLOYER

FULL NAME OF COMPANY

(AREA CODE)

TELEPHONE

STREET ADDRESS

CITY

STATE

ZIP

NAME & TITLE OF SUPERVISOR

TITLE OF YOUR POSITION

SALARY BEGIN

SALARY END

EMPLOYED START MO/YR MO/YR

EMPLOYED END MO/YR MO/YR

REASON FOR LEAVING:

LIST JOBS HELD, DUTIES PERFORMED, SKILLS USED, & PROMOTIONS WHILE EMPLOYED AT THIS COMPANY:

(AREA CODE)

FULL NAME OF COMPANY

TELEPHONE

STREET ADDRESS

CITY

STATE

ZIP

NAME & TITLE OF SUPERVISOR

TITLE OF YOUR POSITION

SALARY BEGIN

SALARY END

EMPLOYED START MO/YR MO/YR

EMPLOYED END MO/YR MO/YR

REASON FOR LEAVING:

LIST JOBS HELD, DUTIES PERFORMED, SKILLS USED, & PROMOTIONS WHILE EMPLOYED AT THIS COMPANY:

READ CAREFULLY: I certify that the information contained in this application is correct to the best of my knowledge and understand that any misstatement or omission of information may result in denial of employment or discharge. I authorize the references 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 all parties fromall liability for any damage that may result from furnishing same to you.

Drug Testing Consent Form

I have applied for employment with Pleiman Landscaping in a position that requires me to operate an automobile or truck. As a condition for my application being considered, I understand and agree to undergo substance screening. I understand that if my test results are positive, I shall not be considered further by Pleiman Landscaping for a car or truck driver position.

I hereby authorize any physician, laboratory, hospital or medical professional retained by Pleiman Landscaping for screening purposes to conduct such screening and to provide the results to Pleiman Landscaping, and I release Pleiman Landscaping and any person affiliated with Pleiman Landscaping and any such institution or person conducting the screening, from liability therefor.

Applicant Information Release

I hereby authorize any person, educational institution, or company I have listed as a reference on my employment application to disclose in good faith any information they may have regarding my qualifications and fitness for employment. I will hold Pleiman Landscaping, any former employers, educational institutions, and any other persons giving references free of liability for the exchange of this information and any other reasonable and necessary information incident to the employment process.

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GENERAL INFORMATION

EDUCATION & TRAINING:

SKILLS

EMPLOYMENT HISTORY

PRESENT OR MOST RECENT EMPLOYER

Drug Testing Consent Form

Applicant Information Release

Contact info