Last Name
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First Name
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Middle
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Address
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City
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| State
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Zip Code
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Phone Number
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Message Phone
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| 1) Are you legally authorized to work in the United States?
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| 2) Will you now or in the future require sponsorship for employment visa status? (e.g., H-1B status)
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3) For what positions are you applying?
List up to 3 positions
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| 4) For what type of work are you applying?
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| 5) Are you 18 years of age or older?
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| 6) How were you referred for employment?
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| Name of referral source?
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7) List any friends or relatives employed by Pacific Green Landscape, Inc.
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| 8) What is the relationship?
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| 9) Have you ever been employed by Pacific Green Landscape, Inc.?
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| EDUCATION |
High School/Institution Name:
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Diploma OR GED
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Address
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City
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| State
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Zip Code
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ADVANCED EDUCATION - COLLEGE, UNIVERSITY, OR VOCATIONAL/TECHNICAL
Applicants will be asked to furnish transcripts of school or college work where appropriate |
Name of Institution
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Address
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City
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| State
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Zip Code
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Dates Attended
From: to
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Did You Graduate?
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| Degree or Certificate Granted |
Credits |
| Major/Minor, or Other Course of Study |
GPA |
| |
Name of Institution
|
Address
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City
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| State
|
Zip Code
|
Dates Attended
From: to
|
Did You Graduate?
|
| Degree or Certificate Granted |
Credits |
| Major/Minor, or Other Course of Study |
GPA |
| |
Name of Institution
|
Address
|
City
|
| State
|
Zip Code
|
Dates Attended
From: to
|
Did You Graduate?
|
| Degree or Certificate Granted |
Credits |
| Major/Minor, or Other Course of Study |
GPA |
| |
Scholastic Awards, Honors, Etc.:
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| MILITARY |
| U.S. Military Service
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Have You Separated?
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| Branch:
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Rank
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Reserve Status
Special Military Training
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| 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.
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| Most Recent Employer
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| Dates of Employment
From: to
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| Business Phone
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May We Contact You Here?
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Address
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City
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| State
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Zip Code
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| Supervisor's Name
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Supervisor's Title
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| Supervisor's Phone
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May We Contact?
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| Salary (Base Pay)
|
Start $
End $
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| Last Increase Date
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| Your Title and Responsibilities
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| 1ST PREVIOUS EMPLOYER:
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| Dates of Employment
From: to
|
| Business Phone
|
May We Contact You Here?
|
Address
|
City
|
| State
|
Zip Code
|
| Supervisor's Name
|
Supervisor's Title
|
| Supervisor's Phone
|
May We Contact
|
| Salary (Base Pay)
|
Start $
End $
|
| Last Increase Date
|
| Your Title and Responsibilities
|
| |
| 2ND PREVIOUS EMPLOYER:
|
| Dates of Employment
From: to
|
| Business Phone
|
May We Contact You Here?
|
Address
|
City
|
| State
|
Zip Code
|
| Supervisor's Name
|
Supervisor's Title
|
| Supervisor's Phone
|
May We Contact?
|
| Salary (Base Pay)
|
Start $
End $
|
| Last Increase Date
|
| Your Title and Responsibilities
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Have you ever been discharged from any job?
IF YES, EXPLAIN:
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| REFERENCES |
| Please list three professional references (preferably previous supervisors, teachers, etc.) whom we may contact regarding your qualifications. |
Name
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Occupation
|
Address
|
City
|
| State
|
Zip Code
|
Name
|
Occupation
|
Address
|
City
|
| State
|
Zip Code
|
Name
|
Occupation
|
Address
|
City
|
| State
|
Zip Code
|
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| GENERAL |
| Have you ever been convicted of a crime?
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| If yes, give offense, date and disposition of case:
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| You are not required to disclose convictions for which the record has been judicially expunged, sealed or eradicated, misdemeanor 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. |
List activities, volunteer work, memberships in professional, honorary, and/or scientific or engineering societies or other information you feel would be of use in evaluating your qualifications. You may omit those which indicate your race, color, national origin, ancestry, religion, sex, age or political affiliations:
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| SKILLS |
| List all computer languages and hardware with which you are familiar:
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| Office Skills (if applicable):
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| Check all that apply: *Testing may be required. |
Typing, WPM
Dictaphone
PBX
Shorthand, WPM
Word Processor,
Specify types:
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Internet
Microsoft Word
Microsoft Excel
General PC navigation
Other
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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 understand any offer of employment is contingent upon my successfully passing the 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.
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