Urban Lawncare - Employment

Last Name

First

M.I.

Address

Apartment / Unit Number

City

State

Zip

Phone

Email Address

Date Available

Desired Salary

Position Applying for

Are you a citizen of the United States?

Yes No

If no, are you authorized to work in the U.S.?

Yes No

Have you ever worked for this company?

Yes No

If yes, when?

Have you ever been convicted of a felony?

Yes No

If yes, please explain:

Education Information

Address

From

To

Did you graduate?

Yes No

College

Degree

Address

From

To:

Did you graduate?

Yes No

Other education

Degree, Certification, Training

Address

From

To:

Did you graduate?

Yes No

Please list three professional references.

Address

Relationship

Phone

Company

Full Name

Address

Relationship

Phone Number

Company

Full Name

Address

Relationship

Phone Number

Company

Previous Employment

Address

Phone Number

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

From:

To:

Reason for Leaving

May we contact your previous supervisor?

Yes No

Previous Employment 2

Address

Phone Number

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

From:

To:

Reason for Leaving

May we contact your previous supervisor?

Yes No

Previous Employment 3

Address

Phone Number

Supervisor

Job Title

Starting Salary

Ending Salary

Responsibilities

From:

To:

Reason for Leaving

May we contact your previous supervisor?

Yes No

Military Service

From:

To:

Rank at Discharge

Type of Discharge

If Other

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. By submitting this application I understand that I am digitally signing this document.

Date

Employment Application

5537 Highway 73 Atchison, KS 66002