Name

Present Address

How long you resided here:

Email Address

Home Phone:

Mobile Phone:

If under 18, please list age:

Position applied for:

Desired starting pay:

Employment desired:
 Full-Time Only Part-Time Only Full or Part Time

How many hours can you work weekly?

Can you work nights?
 Yes No Maybe

When are you available for work?

EDUCATION SECTION

High School you attended:
Graduated:  Yes No

College you attended:
Major:
Graduated:  Yes No

Trade or Professional School you attended:
Concentration:
Graduated:  Yes No

Have you ever been convicted of a crime?

 Yes No

If yes, explain number of conviction(s), nature of offense(s) leading to conviction(s), how recently such offense(s) was/were committed, sentence(s) imposed, and type(s) of rehabilitation:

DRIVER LICENSE INFORMATION

Do you have a driver's license?
 Yes No

What is your means of transportation to work?

Driver's license number:
State of issue:
Class of license: Operator Commercial (CDL) Chauffeur
Expiration date:
Have you had any accidents during the past 3 years?  Yes No
Have you had any moving violations during the past three years?  Yes No

OFFICE STAFF ONLY

Typing skills:  Yes No / WPM: [typingskills]

Personal computer:  Yes No
 PC Mac Linux

REFERENCES SECTION
Please list two references other than relatives or previous employers.

Name:
Position:
Company:
Address:
Telephone:
Relationship:

Name:
Position:
Company:
Address:
Telephone:
Relationship:

ADDITIONAL APPLICANT INFORMATON

An application form sometimes makes it difficult for an individual to adequately summarize a complete background. Use the space below to summarize any additional information necessary to describe your full qualifications for a specific position for which you are applying.

MILITARY SECTION
How you ever been in the armed forces?
 Yes No

Are you now a member of the national guard?
 Yes No

Speciality:
Date Entered:
Discharge Date:
Honorable:  Yes No

WORK EXPERIENCE SECTION
Please list your work experience for the past 5 years beginning with your most recent job held. If you were self-employed, give firm name.

Name:
Address:
Telephone:
Name of last supervisor:
Employment dates:
Pay scale:
Your last job title:
Reason for leaving (be specific):

List of the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

Name:
Address:
Telephone:
Name of last supervisor:
Employment dates:
Pay scale:
Your last job title:
Reason for leaving (be specific):

List of the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

Name:
Address:
Telephone:
Name of last supervisor:
Employment dates:
Pay scale:
Your last job title:
Reason for leaving (be specific):

List of the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company:

May we contact your present employer?  Yes No

Did you complete this application yourself?  Yes No
If not, who did?

PLEASE READ CAREFULLY - APPLICATION FORM WAVIER

In exchange for the consideration of my job application by North Country Landscapes (hereinafter called “the Company”), I agree that:

Neither the acceptance of this application nor the subsequent entry into any type of employment relationship, either in the position applied for or any other position, and regardless of the contents of employee handbooks, personnel manuals, benefit plans, policy statements, and the like as they may exist from time to time, or other Company practices, shall serve to create an actual or implied contract of employment, or to confer any right to remain an employee of North Country Landscapes, or otherwise to change in any respect the employment-at-will relationship between it and the undersigned, and that relationship cannot be altered except by a written instrument signed by the President /General Manager of the Company. Both the undersigned and Shane Pilato may end the employment relationship at any time, without specified notice or reason. If employed, I understand that the Company may unilaterally change or revise their benefits, policies and procedures and such changes may include reduction in benefits.

I authorize investigation of all statements contained in this application. I understand that the misrepresentation or omission of facts called for is cause for dismissal at any time without any previous notice. I hereby give the Company permission to contact schools, previous employers (unless otherwise indicated), references, and others, and hereby release the Company from any liability as a result of such contract.

I also understand that (1) the Company has a drug and alcohol policy that provides for pre-employment testing as well as testing after employment; (2) consent to and compliance with such policy is a condition of my employment; and (3) continued employment is based on the successful passing of testing under such policy. I further understand that continued employment may be based on the successful passing of job- related physical examinations.

I understand that, in connection with the routine processing of your employment application, the Company may request from a consumer reporting agency an investigative consumer report including information as to my credit records, character, general reputation, personal characteristics, and mode of living. Upon written request from me, the Company, will provide me with additional information concerning the nature and scope of any such report requested by it, as required by the Fair Credit Reporting Act.

I further understand that my employment with the Company shall be probationary for a period of sixty (60) days, and further that at any time during the probationary period or thereafter, my employment relation with the Company is terminable at will for any reason by either party.

Your typed signature in the blow box constitutes agreement with the above information and is considered a legal replacement for a handwritten signature.

Your Signature:

This Company is an equal employment opportunity employer. We adhere to a policy of making employment decisions without regard to race, color, religion, sex, sexual orientation, national origin, citizenship, age or disability. We assure you that your opportunity for employment with this Company depends solely on your qualifications.