Employment

Name:*

Address:*

City:*

State:*

Zipcode:*

Phone:*

Email:*

Date Available:*

Desired Salary:*

Position Applying For:*

Are you a U.S. Citizen?*

Yes   No

If NO, are you authorized to work in the U.S.?

Yes   No

Have you ever worked for Clipper Landscape?*

Yes   No

If YES, when?

Have you ever been convicted of a felony?*

Yes   No

If YES, explain?

High School:*

Address:*

From:*

To:*

Did you graduate?*

Yes   No

Degree:

College:*

Address:*

From:*

To:*

Did you graduate?*

Yes   No

Degree:

Please list three professional references.

Full Name:*

Relationship:*

Company:*

Phone:*

Full Name:*

Relationship:*

Company:*

Phone:*

Full Name:*

Relationship:*

Company:*

Phone:*

Company:*

Phone:*

Address:*

Supervisor:*

Job Title:*

Starting Salary:*

Ending Salary:*

Responsibilities:*

From:*

To:*

Reason for leaving:*

May we contact your previous supervisor for a reference?*

Yes   No

Company:*

Phone:*

Address:*

Supervisor:*

Job Title:*

Starting Salary:*

Ending Salary:*

Responsibilities:*

From:*

To:*

Reason for leaving:*

May we contact your previous supervisor for a reference?*

Yes   No

Company:*

Phone:*

Address:*

Supervisor:*

Job Title:*

Starting Salary:*

Ending Salary:*

Responsibilities:*

From:*

To:*

Reason for leaving:*

May we contact your previous supervisor for a reference?*

Yes   No

Name:*

Phone:*

Relationship:*

Cell Phone:*

Address:*

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release.

Signature:*