Position Applied For

Legal First Name

Legal Middle Name

Legal Last Name

Mailing Address

Address Line 1

City

State

Zip Code

Country

Email

Age Over 18?

Yes

No

Preferred Working Hours

Date / Time

Desired Hourly Wage

How did you learn about Kelley Lawn & Landscaping?

Select highest grade completed

If you did not complete high school, do you have a high school equivalency diploma

Select number of years of post high school education

Year Completed

Date Received

Do you have a current driver license?

If so, what state

1) Type

1) License Number

1) Issued by

2) Type

2) License Number

2) Issued by

3) Type

3) License Number

3) Issued by

If you expect to complete an educational program in the near future, please note what type of degree or program and expected completion date.

Please list any additional training, skills, seminars, workshops, special achievements, or specialized skills that you would like us to consider when reviewing your application.

1) Job Title

1) Employer

1) Address

Address Line 1

City

State

Zip Code

Country

1) Phone

1) Immediate Supervisor

1) Salary (start)

1) Salary (finish)

1) Date Start

1) Date End

1) Full or Part Time

1) Number of Hours

1) Duties

1) Number of Employees you supervised

1) Equipment Used

1) Reason for leaving

1) Your name if different from present

2) Job Title

2) Employer

2) Address

Address Line 1

City

State

Zip Code

Country

2) Phone

2) Immediate Supervisor

2) Salary (start)

2) Salary (finish)

2) Date Start

2) Date End

2) Full or Part Time

2) Number of Hours

2) Duties

2) Number of Employees you supervised

2) Equipment Used

2) Reason for leaving

2) Your name if different from present

3) Job Title

3) Employer

3) Address

Address Line 1

City

State

Zip Code

Country

3) Phone

3) Immediate Supervisor

3) Salary (start)

3) Salary (finish)

3) Date Start

3) Date End

3) Full or Part Time

3) Number of Hours

3) Duties

3) Number of Employees you supervised

3) Equipment Used

3) Reason for leaving

3) Your name if different from present

1) Reference Name

1) Business

1) Phone

1) Relationship

2) Reference Name

2) Business

2) Phone

2) Relationship

3) Reference Name

3) Business

3) Phone

3) Relationship

Have you ever been convicted of a crime?

If yes, in which state?

Explain

Are you willing to take a UA/Breathalyzer test for drug or alcohol use?

If no, please explain

What recent activities or accomplishments have you found particularly satisfying and why?

Describe an ideal work environment. What can you offer to Kelly Lawn & Landscaping?

Can you perform functions of this job, with or without accommodation, including lifting regularly, stooping and bending frequently, performing repetitive hand motions, and remaining on your feet for long periods of time?

Any pre-existing medical conditiond that we should be aware of that may limit your ability to preform this job?

Name

Address

Address Line 1

City

State

Zip Code

Country

Phone

Relationship

By submitting this form I hereby certify that all information provided on this application is true and correct to the best of my knowledge. I understand and agree that any falsification of the information herein, regardless of time of discovery, may cause forfeiture on my part to any employment with Kelly Lawn & Landscaping. I understand that all information is subject to verification and I consent to criminal background checks. I also consent to references and former employers and educational institutions listed being contacted regarding this application. I authorize Kelly Lawn & Landscaping to rely upon and use, as it sees fit, any information received from these contacts.