Employment – Graczyk Lawn & Landscape

First Name

Last Name

Street Address

Apartment/Unit #

City

State

Zip Code

Home Phone

Cell Phone

Work Phone

Date Available

Desired Salary

Per hour Per year

Do you have a valid driver's license?

Yes No

Position Applied for

FT PT Temp

How much overtime are you comfortable with (hrs/wk)

Are you on lay-off and subject to recall

Yes No

Are you legally authorized to work in the U.S.?

Yes No

Have you ever worked for this company?

Yes No

Education

High School

City, ST

Did you graduate?

Yes No

Degree

College

City, ST

Did you graduate?

Yes No

Degree

Vocational / Technical

City, ST

Did you graduate?

Yes No

Degree

Other

References

please list three supervisor references.

Full Name

Relationship

Company

Phone

City, ST

Full Name

Relationship

Company

Phone

City, ST

Full Name

Relationship

Company

Phone

City, ST

Current & Previous Employment/Assignments

please list your last 5 employers, assignments or volunteer activities, starting with the most recent. Please explain any gaps in employment in the comments section below. Incomplete information could disqualify you from further consideration.

Company

Phone

Address

Immediate Supervisor Name & Title

Primary type of business

Your Job Title

Responsibilities

Start Date

End Date

May we contact your previous supervisor for a reference?

Yes No Only if I am a finalist

Reason for Leaving

Company

Phone

Address

Immediate Supervisor Name & Title

Primary type of business

Your Job Title

Responsibilities

Start Date

End Date

May we contact your previous supervisor for a reference?

Yes No Only if I am a finalist

Reason for Leaving

Company

Phone

Address

Immediate Supervisor Name & Title

Primary type of business

Your Job Title

Responsibilities

Start Date

End Date

May we contact your previous supervisor for a reference?

Yes No Only if I am a finalist

Reason for Leaving

Company

Phone

Address

Immediate Supervisor Name & Title

Primary type of business

Your Job Title

Responsibilities

Start Date

End Date

May we contact your previous supervisor for a reference?

Yes No Only if I am a finalist

Reason for Leaving

Company

Phone

Address

Immediate Supervisor Name & Title

Primary type of business

Your Job Title

Responsibilities

Start Date

End Date

May we contact your previous supervisor for a reference?

Yes No Only if I am a finalist

Reason for Leaving

Explain any gaps in employment. List any professional, trade, business or civic activities and offices held. You may exclude membership that would reveal gender, race, religion, national origin, ancestry, age, disability or any other protected status.

Comments/Additional Information

Language

List any languages that you can speak, read or write that could be of benefit to the position applied for.

Language

Speak

Fluent Good Fair

Read

Fluent Good Fair

Write

Fluent Good Fair

Language

Speak

Fluent Good Fair

Read

Fluent Good Fair

Write

Fluent Good Fair

Skills/Certifications

Identify skills or certifications you possess related to this position

Skill/Certification

Years of Experience:

Skill/Certification

Years of Experience:

Skill/Certification

Years of Experience:

Skill/Certification

Years of Experience:

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

I understand that failure to reveal any prior employer, or giving false or misleading information by me on any part of this Application for Employment can result in disqualification for employment consideration or, if hired, may be grounds for termination from the company or its' subsidiaries. I understand that if I am hired, my employment is for no definite time and may be terminated at any time without prior notice.

Full Name

Date