Employment Application

Maintenance Foreman

Present Address

First Name

Last Name

Initial

Number & Street

City

State

Zip Code

Home Phone

Cell / Other Phone #

E-mail Address

Employment Desired

Full Time

Part Time

Temporary

Are You Available For Work On

Weekends

Evenings

Holidays

Overtime

If Hired, What Date Can You Start Work?

Personal Information

Have You Ever Applied To Or Worked For Conserve LandCare Before?

Yes

If So, When?

Do You Have Any Friends Or Relatives Working For Conserve LandCare?

Yes

If Yes, State Name(s) And Relationship

Name

Relationship

If Hired, Would You Have A Reliable Means Of Transportation To And From Work?

Yes

Are You At Least 18 Years Old? (If Under 18, Hire Is Subject To Verification That You Are Of Minimum Legal Age.)

Yes

If Hired, Can You Present Evidence Of Your U.S. Citizenship Or Proof Of Your Legal Right To Live And Work In This Country?

Yes

Are You Able To Perform The Essential Functions Of The Job For Which You Are Applying, Either With Or Without Reasonable Accommodation?

Yes

If No, Describe The Function(s) That Cannot Be Performed:

(Note: We Comply With The ADA And Consider Reasonable Accommodation Measures That May Be Necessary For Eligible Applicants/employees To Perform Essential Functions. Hire May Be Subject To Passing A Medical Examination And To Skill And Agility Tests.)

We May Refuse To Hire Relatives Of Present Employees If Doing So Could Result In Actual Potential Problems In Supervision, Security, Safety, Or Morale, Or If Doing So Could Create Conflicts Of Interest.

Education, Training And Experience

High School

Name

Address

City

State

Zip

Did You Graduate?

Yes

Number Of Years Completed

Degree Or Diploma

College / University

Name

Address

City

State

Zip

Did You Graduate?

Yes

Number Of Years Completed

Degree Or Diploma

Other / Vocational / Business

Name

Address

City

State

Zip

Did You Graduate?

Yes

Number Of Years Completed

Degree Or Diploma

Summarize Any Special Training, Skills, Licenses And/or Certificates That May Assist You In Performing The Position For Which You Are Applying

Computer Skills

Check Appropriate Boxes. Include Software Titles And Years Of Experience.

Word Processing Software

Years

Spreadsheet Software

Years

E-mail Software

Years

Internet Software

Years

PowerPoint Software

Years

Other Software

Years

Other Software

Years

Other Software

Years

References

List Below Three Persons, not Related To You, Who Have Knowledge Of Your Work Performance Within The Last Five Years.

Name

Occupation

Telephone

Number Of Yers Acquainted

Name

Occupation

Telephone

Number Of Yers Acquainted

Name

Occupation

Telephone

Number Of Yers Acquainted

Employment History

List Below All Present And Past Employment Starting With Your Most recent Employer. Account For All Periods Of Unemployment. You Must Complete This Section Even If Attaching A Resume.

Name Of Employer

Telephone Number

Type Of Business

Your Supervisor’s Name

Address

City

State

Zip

Dates Of Employment
From: - To:

Your Position And Duties

Reason For Leaving

What Did You Like Most About Your Position?

What Were The Things You Liked Least About The Position?

Name Of Employer

Telephone Number

Type Of Business

Your Supervisor’s Name

Address

City

State

Zip

Dates Of Employment
From: - To:

Your Position And Duties

Reason For Leaving

What Did You Like Most About Your Position?

What Were The Things You Liked Least About The Position?

Name Of Employer

Telephone Number

Type Of Business

Your Supervisor’s Name

Address

City

State

Zip

Dates Of Employment
From: - To:

Your Position And Duties

Reason For Leaving

What Did You Like Most About Your Position?

What Were The Things You Liked Least About The Position?

If Not Addressed On Previous Pages, Have You Ever Been Fired Or Asked To Resign From A Job?

Yes

If Yes, Please Explain

Explain Any Gaps In Your Employment Other Than Those Due To Personal Illness, Injury Or Disability.

Attach Your Resume Here (PDF Format)

Please Read Carefully And Check "Yes" Or "No" Below Each Paragraph

I Hereby Certify That I Have Not Knowingly Withheld Any Information That Might Adversely Affect My Chances For Employment And That The Answers Given By Me Are True And Correct To The Best Of My Knowledge. I Further Certify That I, The Undersigned Applicant, Have Personally Completed This Application. I Understand That Any Omission Or Misstatement Of Material Fact On This Application Or On Any Document Used To Secure Employment Shall Be Grounds For Rejection Of This Application Or For Immediate Discharge If I Am Employed, Regardless Of The Time Elapsed Before Discovery.

Yes

I Hereby Authorize The Company To Investigate My References, Work Record, Education, And Other Matters Related To My Suitability For Employment And, Further, Authorize The References I Have Listed To Disclose To The Company Any And All Letters, Reports And Other Information Related To My Work Records, Without Giving Me Prior Notice Of Such Disclosure. In Addition, I Hereby Release The Company, My Former Employers And All Other Persons, Corporations, Partnerships And Associations From Any And All Claims, Demands Or Liabilities Arising Out Of Or In Any Way Related To Such Investigation Or Disclosure

Yes

I Understand That The Company May Require Applicants For Employment To Take A Urinalysis For Drug And Alcohol Screening As Part Of The Selection Process, And That Any Offer Of Employment With The Company Is Contingent Upon The Results Of These Tests Being Satisfactory. I Understand That If I Am Employed With The Company, It May Require That I Submit To A Drug And/or Alcohol Screen If I Am Involved In An On-the-job Accident Or If The Company Has Reasonable Suspicion That I Am Under The Influence Of Drugs Or Alcohol; And I Hereby Authorize The Release Of These Drug Screen Results To The Company.

Yes

I Understand That nothing Contained In The Application, Or Conveyed During Any Interview Which May Be Granted Or During My Employment, If Hired, Is Intended To Create An Employment Contract Between Me And The Company. In Addition, I Understand And Agree That If I Am Employed, My Employment Is For No Definite Or Determinable Period And May Be Terminated At Any Time, With Or Without Prior Notice, At The Option Of Either Myself Or The Company, And That No Promises Or Representations Contrary To The Foregoing Are Binding On The Company Unless Made In Writing And Signed By Me And The Company’s Designated Representative.

Yes

Should A Search Of Public Records Be Conducted By Internal Personnel Employed By The Company, I Am Entitled To Copies Of Any Such Public Records Obtained By The Company Unless I Mark The Check Box Below. If I Am Not Hired As A Result Of Such Information, I Am Entitled To A Copy Of Any Such Records Even Though I Have Checked The Box Below. “Public Records” Are Defined By California State Law And Means Records Documenting An “arrest, Indictment, Conviction, Civil Judicial Action, Tax Lien, Or Outstanding Judgment.” (Civil Code Section 1786.53) Any Public Records Request Conducted By Internal Personnel Employed By The Company Will Only Be Used To The Extent Allowed By Federal, State, Or Local Law

Yes

In Compliance With Federal Law, All Persons Hired Will Be Required To Verify Identity And Eligibility To Work In The United States And To Complete The Required Employment Eligibility Verification Document Form Upon Hire.

Yes

I Waive Receipt Of A Copy Of Any Public Record Described In The Paragraph Above.

Yes

Submit