APPLY FOR A POSITION

First Name, Middle Initial, Last Name

Street

City, State, Zip

Phone

Email Address

SS#

Driver's License#

License State#

U.S. Citizen? U.S. Citizen? yes no

If not, are you legally allowed to work in the United States? If not, are you legally allowed to work in the United States? yes no

Are you over the age of 18? Are you over the age of 18? yes no

Have you ever been convicted of a crime? Have you ever been convicted of a crime? yes no

Please describe. Answering “yes” to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.

Position Information:

What position are you applying for?

How did you hear about this job?

Type of employment desired: Type of employment desired: part time full time seasonal temporary

Are you able to perform the functions of the job for which you are applying? Are you able to perform the functions of the job for which you are applying? yes no

Would you be able to work weekends? Would you be able to work weekends? yes no

When can you start?

Desired Hourly Compensation:

Employment History: Present or Most Recent Employer:

Present or Most Recent Employer:

Employer Address:

Employer Phone:

Position:

Salary:

Duties:

Dates of Employment:

Supervisor Name & Title:

May we contact this employer for a reference? May we contact this employer for a reference? yes no

Reasons for Leaving:

Prior Employers:

Prior Employer:

Employer Address:

Employer Phone:

Position:

Salary:

Duties:

Supervisor Name & Title:

Dates of Employment:

May we contact this employer for a reference? May we contact this employer for a reference? yes no

Reasons for Leaving:

Education:

High School Name & Address:

Did you graduate?: Did you graduate?: yes no GED

Technical School or Vocational School:

Technical School or Vocational School Name & Address:

Did you graduate?: Did you graduate?: yes no

Years Attended:

Degree or Certification:

Specialty:

College or University:

College or University School Name & Address:

Did you graduate?: Did you graduate?: yes no

Years Attended:

Major:

Degree or Certification:

Skills or Qualifications:

Computer, Languages Spoken (other than English), Other Skills:

References: Name three persons (not relatives, former employers or personnel of this company) who have known you for at least 2 years:

Reference 1:

Name:

Address:

Business & Location:

Phone:

Reference 2:

Name:

Business & Location:

Address:

Phone:

Reference 3:

Name:

Business & Location:

Address:

Phone:

Grass Roots Lawn & Landscape is an equal opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, age, sex, religion, national origin, handicap or marital status. Your opportunity for employment depends solely upon your qualifications. I hereby certify that my answers and assertions set forth in this application are true and complete to the best of my knowledge. If I am employed, I understand that any false statements on this application shall be considered sufficient cause for my dismissal. I hereby authorize this company to investigate any aspect of my prior educational and employment history. Furthermore, I understand that if I am hired, employment with this company is “at will,” which means that either the company or I can terminate my employment for any reason not prohibited by state or federal law.

Type name to acknowledge that you understand the above statement:

Employment Reference Authorization And Release. I have been requested to provide information for the purpose of reviewing my qualifications and background. Therefore, I authorize Grassroots Lawn & Landscape, Inc. to investigate my past and present records as well as reference information both private and public. I release from liability or damages, any person, company or organization providing actual information about my qualifications and related characteristics to Grass Roots Lawn & Landscape, Inc. I also authorize the release of such records and information to and from Grass Roots Lawn & Landscape, Inc. and do release all persons, agencies, firms companies etc, from any liability or damages resulting from the investigation, collection and/or release of such records and information. This authorization is valid for 90 days from the date of my signature below. Type name to acknowledge that you understand the above statement:

Type name to acknowledge that you understand the above statement: