Simple Job Application Form

Date

Full Name*

First NameMiddle NameLast Name

Current Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email Address*

example@example.com

Phone Number

Social Security Number

Do you have a valid driver's license?

YesNo

Do you have a reliable means of transportation?

YesNo

Are you prevented from lawful employment in the U.S. because of visa or immigration status?

YesNo

Have you ever been convicted of a felony?

YesNo

Have you ever been employed by Zanescapes before?

YesNo

If yes, what were your dates of employment at Zanescapes?

What is your employment availability?

Full-timePart-time

Are you currently attending school or university?

YesNo

Desired position?

When can you start?

What is your highest level of education?

School name, address & course of study

Year Completed

Degree/Cert./Diploma

Position

Name of Organization

Phone number

Supervisor

May we contact?

YesNo

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Start Date

Date

End Date

Date

Duties

Starting wage

Ending wage

Job Status

Full-timePart-timeOther

Position

Name of Organization

Phone number

Supervisor

May we contact?

YesNo

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Start Date

Date

End Date

Date

Duties

Starting wage

Ending wage

Job Status

Full-timePart-timeOther

Any Special Skills?

Licenses - CDL, Hydraulics, etc.

Equipment operation experience

Are you able to bend to lift from the ground?

YesNo

Are you able to work outdoors in all seasons?

YesNo

Are you able to drive a vehicle?

YesNo

Are you able to do handwork with a hoe, rake or other tool?

YesNo

Are you able to handle gasoline, diesel fuel, insecticides, etc.?

YesNo

Are you able to spend hours on your feet?

YesNo

Are you able to lift heavy loads up to 80 pounds?

YesNo

Are you able to extend your hours to complete a job?

YesNo

Do you have pre-existing knowledge of plants, gardening and/or landscaping?

YesNo

If you answered yes to the last question, please describe here:

If you answered no to any of the above questions please explain why here:

Emergency contact information (names and phone numbers)

References (names and contact information)

*I certify that all of the information I have provided in order to apply for and secure work with the employer is true, complete and correct.
*I expressly authorize, without reservation, the employer, its representatives, employees or agents to contact and obtain information from all references, employers, public agencies, licensing authorities and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview.
I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees or representatives, for seeking, gathering and using such information in the employment process and all other persons, corporations or organizations for furnishing such information about me.
*I understand that the employer does not unlawfully discriminate in employment and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state or federal law.
*I understand that this application remains current for 90 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application.
*If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same rights to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specific period or defined duration. I understand that no supervisor or representative of the employer is authorized to make any assurance to the contrary and that no implied, oral or written agreements contrary to the foregoing expressed language are valid unless they are in writing and signed by the employer’s president.
*I also understand that if I am hired, I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
*I understand that any information provided by me that is found to be false, incomplete or misrepresented in any respect will be sufficient cause to (i) cancel further consideration of this application, or (ii) immediately discharge me from the employer’s service whenever it is discovered.
Before submitting, ensure the above statements are true *

Signature

Job Application

Work Experience

Employer 1

Employer 2