Kelly’s Greenscapes
Application for Employment
Our policy is to provide equal
employment opportunity to all qualified persons without regard to race, creed,
color, religious belief, sex, age, national origin, ancestry, physical or mental
disability, or veteran status.
Date ______________
Last name ________________________
First name ________________ Middle name________
Street Address
_________________________________________________________________
City
_____________________
State
_______ ZIP _______
Telephone
___________________________ Social Security # ___________________________
Position applied for
__________________________________________
How did you hear of this opening?
__________________________________________
When can you start?
_____________________ Desired Wage
$______________
Are you a
U.S.
citizen or otherwise authorized to work in the
U.S.
on an unrestricted basis? (You may be required to provide documentation.) q
Yes q
No
Are you looking for full-time
employment? q
Yes q
No
If no, what hours are you
available? ______________
Are you willing to work swing
shift? q
Yes q
No
Are you willing to work graveyard?
q
Yes q
No
Have you ever been convicted of a
felony? (This will not necessarily affect your application.)
q
Yes q
No
If yes, please describe
conditions. __________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Education
School Name and
Location
Year Major
Degree
High School
________________________________________
______ ______ ______
College
___________________________________________
______ ______ ______
College
___________________________________________
______ ______ ______
Post-College
_______________________________________
______ ______ ______
Other Training
______________________________________
______ ______ ______
In addition to your work history,
are there other skills, qualifications, or experience that we should consider?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Employment History (Start with
most recent employer)
Company Name
________________________________________________________________
Address
____________________________________ Telephone _________________________
Date Started ___________
Starting Wage ____________ Starting
Position ________________
Date Ended _____________
Ending Wage ____________ Ending
Position ________________
Name of Supervisor
____________________________________
May we contact? q
Yes q
No
Responsibilities
_______________________________________________________________
_____________________________________________________________________________
Reason for leaving
______________________________________________________________
Company Name
________________________________________________________________
Address
________________________________________ Telephone _____________________
Date Started ____________
Starting Wage ____________ Starting
Position _______________
Date Ended _____________
Ending Wage ____________ Ending
Position ________________
Name of Supervisor
____________________________________
May we contact?
q
Yes q
No
Responsibilities
________________________________________________________________
______________________________________________________________________________
Reason for leaving
______________________________________________________________
Company Name
_______________________________________________________________
Address
_______________________________________ Telephone ______________________
Date Started ____________
Starting Wage ____________ Starting
Position _______________
Date Ended _____________
Ending Wage ____________ Ending
Position ________________
Name of Supervisor
____________________________________
May we contact? q
Yes q
No
Responsibilities
________________________________________________________________
______________________________________________________________________________
Reason for leaving
______________________________________________________________
Company Name
________________________________________________________________
Address
_______________________________________ Telephone ______________________
Date Started ____________
Starting Wage ____________ Starting
Position _______________
Date Ended _____________
Ending Wage ____________ Ending
Position ________________
Name of Supervisor
____________________________________
May we contact? q
Yes q
No
Responsibilities
________________________________________________________________
______________________________________________________________________________
Reason for leaving
______________________________________________________________
Attach additional information if
necessary.
I certify that the facts set forth
in this application for employment are true and complete to the best of my
knowledge. I understand that if I am employed, false statements on this
application shall be considered sufficient cause for dismissal. This company is
hereby authorized to make any investigations of my prior educational and
employment history.
Signature_______________________________________________
Date _________________
Fax To Kelly’s Greenscapes,
414-607-7277
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