EMPLOYMENT APPLICATION

Please complete and submit this entire Job Application Packet.

BASIC INFORMATION

Position Desired:

Date

YYYY

First Name

Middle Name

Last Name

Address

Phone Number

Driver's License Number:

State:

Expiration Date:

EMPLOYMENT HISTORY

The information required below must be submitted on this Application. While you are welcome to attach a resume to this Application, it will not be accepted in lieu of completing any portion of this Application. For this section, please account for the last ten (10) years of employment beginning with your current or most recent employer. List all experiences that are relevant to the position for which you are applying.

Employer

Title

Employed From (mm/yy):

Employed To (mm/yy):

Address

Supervisor's Name

Supervisor's Title

Job Responsibilities:

Employer

Title

Employed From (mm/yy):

Employed To (mm/yy):

Address

Supervisor's Name

Supervisor's Title

Job Responsibilities:

Employer

Title

Employed From (mm/yy):

Employed To (mm/yy):

Address

Supervisor's Name

Supervisor's Title

Job Responsibilities:

Education

High School

Location of School

Address

Please select

College

Location of School

Address

Please select

Licenses/Certificates

Please list all relevant Licenses and/or Certificates here:

Additonal Information

Are you legally authorized to work in the United States?

Yes

Can you speak, read, and/or write in English?

Yes

Are you at least 18 years of age?

Yes

Did any Komplete Landscape employee recommend you for this position?

Yes

Can you speak, read, and/or write in Spanish?

Yes

Have you ever been fired from a job?

Yes

References

Name

Relationship

Phone

Name

Relationship

Phone

Name

Relationship

Phone

In Case of Emergency Notify

Name

Relationship

Phone

Address

Medical Provider Network

Komplete Landscape Contractors, Inc. utilizes a Medical Provider Network for the treatment of work-related injuries and illnesses. Employees may pre-designate a physician for this purpose if they wish, provided they have a signed letter from their physician agreeing to the pre-designation for work-related injuries and illnesses. If you wish to do so, please list the physician’s name and contact information below, and attach the physician’s letter. If you do not wish to do so, leave the space blank.

Physician's Name

Contact Information

Please Read Carefully

I fully understand this employment application, as well as other hiring documents, do not create an employment contract between Komplete Landscape Contractors, Inc. and me. I understand that if I am hired and any of my answers are deemed to be false or misrepresentations, then I may be terminated. I fully understand that my employment is “at will”, meaning that either myself or Komplete Landscape Contractors, Inc. may terminate my employment at any time for any reason. I am fully aware and authorize Komplete Landscape Contractors, Inc. to conduct a background investigation and/or a pre-employment drug test and/or physical examination on me as a condition of my employment. I grant full permission to Komplete Landscape Contractors, Inc. to contact the above-mentioned references regarding my background. Komplete Landscape Contractors, Inc. is committed to providing access and reasonable accommodation in its employment for individuals with disabilities.

Signature

Printed Name

Date

YYYY

Verification