Employment - Graczyk Lawn and Landscape

Application

First Name *

Last Name *

Email Address *

Street Address *

Apartment/Unit #

City *

State *

ZIP *

Home Phone

Cell Phone *

Work Phone

Date Available *

Desired Salary *

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

Referral Source

Advertisement Employee Relative School Government Emp. Agency Other

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:

please list any seminars, classes or other education not listed above which may help qualify you for this position.

References

please list three supervisor references.

Full Name *

Company *

City, ST *

Relationship *

Phone *

Email *

Full Name

Company

City, ST

Relationship

Phone

Full Name

Company

City, ST

Relationship

Phone

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

Comments/Additional Information

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.

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:

Ability Level

1 (poor)

5 (expert)

Skill/Certification

Years of Experience:

Ability Level

1 (poor)

5 (expert)

Skill/Certification

Years of Experience:

Ability Level

1 (poor)

5 (expert)

Skill/Certification

Years of Experience:

Ability Level

1 (poor)

5 (expert)

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