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Application for Employment

Please fill out the form below as completely as possible.

 

All new employees are subject to:


  • Drug Screening
  • Employment verification process (employment eligibility to work in the U.S.)

 

Applicant's Name

Residence Address

Contact Information

Are you legally authorized to work in the United States?

Yes      No

For what positions are you applying? List up to 3

For what type of work are you applying?

FULL-TIME     PART-TIME     SUMMER     TEMPORARY    

Are you able to perform the essential functions of the position(s) you are applying for with or without reasonable accommodation?

Yes      No

Are you 18 years of age or older?

Yes      No

How were you referred for employment?

Newspaper - El Latino
Newspaper - PennySaver
Newspaper - Union Tribune
Online Search

Employee Referral
Self
Other

List any friends or relatives employed by Pacific Green Landscape, Inc. & their relationship to you.

Have you ever been employed by Pacific Green Landscape, Inc.?

Yes      No

Education

High School or Institution Name

Yes      No

Location Address

Advanced Education - College, University or Vocational/Technical

Applicants will be asked to furnish transcripts of school or college work where appropriate

Name of Institution

Yes      No

Location Address

Dates Attended

Awards, Certificates, Special Training:

Military

Yes      No

Yes      No

Special Military Training:

Work History

Give employment history as completely as possible, starting with your present or most recent employer. For any unemployment periods, show dates and location. Include U.S. Military Service, if any.

Most Recent Employer

Yes      No

Dates of Employment

Business Address

Supervisor Information

May we contact your supervisor?

Yes      No

Salary

Your Title

Responsibilities

1st Previous Employer

Yes      No

Dates of Employment

Business Address

Supervisor Information

May we contact your supervisor?

Yes      No

Salary

Your Title

Responsibilities

2nd Previous Employer

Yes      No

Dates of Employment

Business Address

Supervisor Information

May we contact your supervisor?

Yes      No

Salary

Your Title

Responsibilities

Have you ever been discharged from any job?

Yes      No

If yes, please explain

References

Please list three professional references (preferably previous supervisors, teachers, etc...) whom we may contact regarding your qualifications.

Reference 1

Address

Reference 2

Address

Reference 3

Address

General

Have you ever been convicted of a crime?

Yes      No

If yes, give offense, date, and disposition of case

You are not required to disclose convictions for which the record has been judicially expunged, sealed, or eradicated, misdeameanor convictions for which probation has been completed and the case dismissed, marijuana possession infractions more than two years old, or convictions for which a pre-guilty plea drug court program has been successfully completed. A conviction will not necessarily disqualify you from employment.

 

PRE-EMPLOYMENT STATEMENT

I certify that the information given by me in this application is true and correct without omissions of any kind. I authorize an inquiry to be made into the information contained in this application if I am considered for employment. I understand that Pacific Green Landscape, Inc. may request me to submit to a pre-employment/post-offer medical examination and drug and alcohol screening tests and I hereby agree and consent to such examination and testing.

I hereby authorize the company to make a complete investigation into all aspects of my background and hereby release the company form any liability in any way connected with that investigation. I also authorize the company to maintain any records related to that investigation. Former employers, educational institutions and references named herein are authorized to give information about me. I hereby release them from all liability for issuing such information. I hereby wave any privilege I have to such information.

I understand that employment is contingent upon me submitting documentary proof of identity and illegal authorization to work in the United States as required.

I understand and acknowledge that if any misrepresentation or omission of facts have been made by me, or if the results of an investigation are not satisfactory for any reason, any consideration, offer, or actual employment by the company may be terminated immediately without obligation or liability to me other than payment at the rate agreed upon, for service actually rendered, if any.

I understand that nothing contained in this employment application or in the granting of an interview, and no company policies, procedures, or handbooks that I might receive, are intended to create an employment contract between the company and myself for a specific length of time or under which I can only be terminated for good cause. I understand that nothing contained in this employment application or in the granting of an interview, and no company policies, procedures or handbooks that I might receive are intended to create an employment contract between the company and myself limiting the company's right to transfer, demote, suspend or administer employee discipline. No promises regarding employment have been made to me and I understand that no such promise or guarantee is binding upon the company unless made in writing by an authorized company representative.

If an employment relationship is established, I understand that the company and I have the right to terminate my employment at any time for any reason. I further understand that if an employment relationship is established, the company retains the absolute right to transfer, demote, or administer employee discipline at any time for any reason. This at-will agreement will remain in effect throughout the duration of my employment and may only be changed by a written agreement signed by me and the President of the company.

 

Signature

By entering my initials into this box, I agree to the pre-employment statement above.

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