General Information

First Name	Last Name
Address
City	State	Zip Code
Daytime Phone	Evening Phone
Email

Please complete the following.
Do you possess a valid Pennsylvania Driver’s License?	yes  no
If yes, please give the operator’s number
Do you possess a valid Commercial Driver’s License (CDL)?	yes  no
If yes, do you have any endorsements?	yes  no
If yes, please list
If yes, do you have any restrictions?	yes  no
If yes, please list
Do you have a Pesticide License?	yes  no
If yes, please give the class
Do you have your own transportation?	yes  no
Can you drive a standard transmission vehicle?	yes  no

---

Education

	Name	City, State	Degree	Dates Enrolled
High School
College
Vo-tech
Military
Other

Awards/Honors

Hobbies/Sports

---

Work Experience (starting with most recent)

Employer 1

Employer Name	Contact Person
Address
City	State	Zip Code
Phone	Start Date	End Date
Job Title	Wage
Reason for Leaving

Employer 2

Employer Name	Contact Person
Address
City	State	Zip Code
Phone	Start Date	End Date
Job Title	Wage
Reason for Leaving

May we contact your present employer?	yes	no
Please list your skills and abilities as related to the position.

---

References (No Relatives Please)

Reference 1

Name	Occupation
Address
City	State	Zip Code
Phone

Reference 2

Name	Occupation
Address
City	State	Zip Code
Phone

---

Position Information

I will be available for work starting	Anticipated Starting Wage
Position Applying For Construction Foreperson Stone Masonry Foreperson Irrigation Foreperson Planting Foreperson Maintenance Foreperson Mowing Foreperson Construction Technician Stone Masonry Technician Irrigation Technician Planting Technician Maintenance Technician Mowing Technician Lawn, Tree, and Shrub Technician Mechanic	Hold Ctrl to select more than one area of interest.
Additional Comments

---

“The Equal Employment Opportunity Commission (EEOC) has issued guidelines setting forth the Commission’s interpretation regarding sexual harassment as a violation of Title VII of the Civil Rights Act of 1964. These guidelines are consistent with our long-standing policy that conduct creating an intimidating, hostile or offensive working environment will not be tolerated and those violating this practice may be subject to disciplinary action up to and including discharge. Any employee who feels that he or she is being subject to sexual or racial harassment, is urged to immediately contact the employee relations department.

I understand and agree that:

1. Any material misrepresentation or deliberate omission of a fact in my application may be justification for refusal of, or if employed, termination from employment.

2. It is my understanding that the company will make a thorough investigation of my entire work and personal history and may verify all data given in my application for employment, related papers, or oral interviews. I authorize such investigation and the giving and receiving of any information requested by the company and I release from liability any person giving or receiving any such information. I understand that falsification of data so given or other derogatory information discovered as a result of this investigation may prevent my being hired, or if hired, may subject me to immediate dismissal.

3. I agree that my employment may be terminated by this Company at any time without liability for wages or salary except such as may have been earned at the date of such termination. If requested by the management at any time, I agree to submit to search of my person or of any locker that may be assigned to me, and I hereby waive all claims for damages on account of such examination. I understand and agree that I may be required to take physical examination, at company expense, at any time to determine if I am physically fit for the job I am to perform, and, I authorize any physician or hospital to release any information which may be necessary to determine my ability to perform the duties of a job I am being considered for prior to employment or in the future during my employment with the company.

4. Although management makes every effort to accommodate individual preferences, business needs may at times make the following conditions mandatory; overtime, shift work, a rotating work schedule, or a work schedule other than Monday through Friday. I understand and accept these as conditions of my continuing employment.

I further understand that this is an application for employment and that no employment contract is being offered.

I understand that if I am employed, such employment is for an indefinite period of time and that the company can change wages, benefits and conditions at any time.

Did you read and understand the above?	yes  no
Did you fill out this application yourself?	yes  no

Signed (please type your name)

Date