Employment Application -

Full Name

Address

City

State

Zip Code

Phone

Driver's License #

Date of Birth

Are you under 18 years of age?

Yes No

Are you legally authorized to work in the United States?

Yes No

Are you a veteran?

Yes No

Do you hold a valid Drivers License that is not suspended or revoked?

Yes No

Have you ever been convicted of, received a sentence for, pled no contest to, placed on probation, or fined for a crime, other than a minor traffic violation?

Yes No

Acknowledgement of disclosed information:

Checking this box is not an automatic bar to employment. Arrest records and juvenile, sealed, and expunged records should not be disclosed. Any other criminal record not disclosed by you may be considered falsification of this application, which may result in revocation of your employment offer or termination of your employment. Also, in accordance with any state or federal regulations, you may be required to provide copies of any criminal records.

Position You're Applying For

Available Start Date

Were you referred to us?

Yes No

Referral's name

Have you worked for Foegley Landscape, Inc. before?

Yes No

When?

Employment desired

Full-time Part-time Seasonal/Temporary

Reference person's name:

Phone Number

Number of years known

Is this person a professional or personal reference?

Professional Personal

Reference person's name:

Phone Number

Number of years known

Is this person a professional or personal reference?

Professional Personal

Reference person's name:

Phone Number

Number of years known

Is this person a professional or personal reference?

Professional Personal

School Name

Location

Degree/Diploma

Did you graduate?

Yes No

School Name

Location

Degree/Diploma

Did you graduate?

Yes No

School Name

Location

Degree/Diploma

Did you graduate?

Yes No

Are you currently employed?

Yes No

What language(s) do you speak, read and/or write??

Name of Company

Okay to contact?

Yes No

City

State

Phone Number

Supervisor's Name

Position Held

Start Date

End Date

Duties

Reason for leaving

Rate of pay

Name of Company

Okay to contact?

Yes No

City

State

Phone Number

Supervisor's Name

Position Held

Start Date

End Date

Duties

Reason for leaving

Rate of pay

Name of Company

Okay to contact?

Yes No

City

State

Phone Number

Supervisor's Name

Position Held

Start Date

End Date

Duties

Reason for leaving

Rate of pay

Previous Employment Check Consent

I authorize Foegley Landscape, Inc. to conduct a reference check with my present and/or previous employer(s).

If "Other," please describe

What are your hobbies outside of work?

Do you or have you helped in volunteer work?

Yes No

If "Yes," please describe

What words describe your character?

What are long-term goals you've set for yourself?

What are some of your proudest achievements?

I acknowledge that I have read the "Conditions of Acceptance of Application by Foegley Landscape, Inc."

Conditions of Acceptance of Application by Foegley Landscape, Inc.

By my signature below, I acknowledge I have read, understand and agree to the following conditions.

Introductory Period Each person hired is given a 90 day introductory period. During this time you will be evaluated as to every aspect of your work. Employees not meeting our standards will be terminated during the 90 day introductory period. However, even if you complete your introductory period, this is not a promise or guarantee of continued employment (See “employment at will” section below).

Employment At Will I understand that this state is an “At-Will” employment state. This means that an employee can leave employment at any time, with or without cause, and with or without notice. This also means that Foegley Landscape, Inc. has the same right to terminate your employment relationship at any time, with or without cause and with or without notice.

I-9 Compliance If you have a legal right to work in the United States, there are laws to protect you against discrimination in the workplace. Federal law requires all employers to verify the identity and employment eligibility of all persons hired to work in the United States. I can provide proof of employment authorization on the first day of work.

State and Federal Certifications I understand that my job may require passing specific pesticide certification examinations, and/or passing the commercial driver’s license test. Failure to do so may result in demotion or dismissal.

Medical and Drug and Alcohol Screening I understand that my involvement in certain tasks may be contingent upon the successful completion of a medical examination by the health care provider chosen by and at Foegley Landscape lnc.’s expense. I understand that I may be required to submit to a pre-employment and/or post-employment test for fitness and/or substance abuse, where not prohibited by law.

Debt Repayment Upon separation of my employment, I authorize this employer to withhold from my final paycheck any monies owed to them by me, or I will be billed the full amount, due immediately.

False Statement I understand that any false statement by me in this application or failure to give any material information requested will be cause for my dismissal of employment.

PDF Version

Acknowledgement of Electronic Signature

I certify that all answers, statements, and data are correct and true to the best of my knowledge.
I have read the "Conditions of Acceptance by Foegley Landscape, Inc." document and elect to electronically sign this form which represents my handwritten signature.

Electronic/Digital Signature of Applicant

Today's Date