Employment Application Page 1 of 5 Employment Application Please complete all required fields! POTENTIAL EMPLOYEES ARE EVALUATED WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, MARITAL OR VETERAN STATUS, THE PRESENCE OF A NON-JOB RELATED HANDICAP OR ANY OTHER LEGALLY PROTECTED STATUS. Position Sought:* Invalid Input How did you learn of this position?* Invalid Input Today's Date: (mm/dd/yyyy)* Invalid Input First Name:* Please let us know your name. Last Name:* Please let us know your name. Address:* Invalid Input City:* Invalid Input State:* AlaskaAlabamaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaVirgin IslandsWashingtonWest VirginiaWisconsinWyoming Invalid Input Zip Code:* Invalid Input Home Number:* Invalid Input Work Number: Invalid Input Cell Number: Invalid Input Your Email: Please let us know your email address. Are you legally eligible to work in the U.S.?* YesNo Invalid Input Education High School High School Name:* Invalid Input High School Location:* Invalid Input Dates Attended:* Invalid Input Did You Graduate High School?* YesNo Invalid Input College Did You Go to College?* YesNo Invalid Input College Name: Invalid Input College Location: Invalid Input Dates Attended College: Invalid Input College Degree Received: Invalid Input List Any Additional Majors: Invalid Input Other School Any Additional Schooling?* YesNo Invalid Input School Name: Invalid Input School Location: Invalid Input Years Attended: Invalid Input Degree Received: Invalid Input Additional Info List skills pertinent to this job: Invalid Input i.e. can operate lawn mower, heavy equipment, etc. Do you have a valid drivers license?* YesNo Invalid Input Employment History Employer #1 (Start with Most Recent Employer First) Employer:* Invalid Input Job Title:* Invalid Input Dates Employed:* Invalid Input Prior position Held with Company (if any): Invalid Input Address: Invalid Input Phone:* Invalid Input Supervisor: Invalid Input Duties Performed:* Invalid Input Reason For Leaving:* Invalid Input Employer #2 Employer: Invalid Input Job Title: Invalid Input Dates Employed: Invalid Input Prior position Held with Company (if any): Invalid Input Address: Invalid Input Phone: Invalid Input Supervisor: Invalid Input Duties Performed: Invalid Input Reason For Leaving: Invalid Input Employer #3 Employer: Invalid Input Job Title: Invalid Input Dates Employed: Invalid Input Prior position Held with Company (if any): Invalid Input Address: Invalid Input Phone: Invalid Input Supervisor: Invalid Input Duties Performed: Invalid Input Reason For Leaving: Invalid Input References Three Professional References Professional Reference #1 Name:* Invalid Input Company Name:* Invalid Input Title:* Invalid Input Phone(s):* Invalid Input Professional Reference #2 Name:* Invalid Input Company Name:* Invalid Input Title:* Invalid Input Phone(s):* Invalid Input Professional Reference #3 Name:* Invalid Input Company Name:* Invalid Input Title:* Invalid Input Phone(s):* Invalid Input Acknowledgement and Authorization I certify that the information contained in this application is correct to the best of my knowledge. I understand that to falsify information is grounds for refusing to hire me, or for discharge should I be hired. I authorize any person, organization or company listed on this application to furnish you any and all information concerning my previous employment, education and qualifications for employment. I also authorize you to request and receive such information. In consideration for my employment, I agree to abide by the rules and regulations of the company, which rules may be changed, withdrawn, added or interpreted at any time, at the company’s sole option and without prior notice to me. I also acknowledge that my employment may be terminated, or any offer or acceptance of employment withdrawn, at any time, with or without cause, and with or without prior notice at the option of the company or myself. SMG Landscapes is a drug and alcohol free workplace and you may be drug tested at any time. Signing this indicates your drug-free status and willingness to submit to a drug test at any time during your employment. Name:* Invalid Input Date:* Invalid Input Please Acknowledge and Agree to the Above:* I Agree Invalid Input