Matt's Lawn Care

First Name

Middle Initial

Last Name

Street Address:

City:

State:

Zip Code:

Email:

Phone:

Birth Date:

Social Security #

Desired Salary/ Pay Rate ($)

Position Applied For:

Date you can start:

Are you capable of lifting 80 lbs?

No
Yes

Can you drive a zero turn?

No
Yes

Availability:

Part-Time
Full-Time
Temporary/ Seasonal

Hourly Rate Expected:

Are you a citizen of the United States?

No
Yes

Convicted of a felony?

No
Yes

If yes, please explain:

Convicted of a misdemeanor?

No
Yes

If yes, please explain:

Are you prescribed medication?

No
Yes
Not at this moment

If so, please explain:

Can you pass a drug screen?

No
Yes

Frequent Drug Screens:

No
Yes
I don't feel comfortable with testing.

Years professionally landscaping:

less than 1
2-3
3-5
5+

Most familiar equipment:

Hedge Trimmer
Edger
Line Trimmer

Do you have a valid Driver's License?

No
Yes

Any accidents in the last 5 years?

No
Yes

If yes, please explain:

Do you live in GA?

No
Yes

Have you ever draw unemployment?

No
Yes

If yes, how long?

Work History:

Are you currently employed?

No
Yes

Have you ever draw workers' comp.?

No
Yes

Sex:

Male
Female

Height:

Weight:

Do you smoke?

No
Yes
Sometimes

Do you have any medical conditions?

No
Yes

If yes, please explain:

Do you drink alcohol?

No
Rarely
Sometimes

Work Experience:

List names and address:

Years/ Months Worked?

Reasons for leaving:

Why you should be hired?

Reference #1

Reference #2

Reference #3

Education

GED
High School Diploma
Some College
Degree

Employment Disclamer

APPLICANT’S STATEMENT AND CONDITION OF EMPLOYMENT (Please read carefully before signing) “I understand that an investigative consumer report involving information concerning my character, employment history, general reputation, police record, personal habits, made of living, credit and indebtedness may be obtained prior to any final offer of employment. Upon timely written request to the personnel department of the company, the nature and scope of the report will be disclosed to me.” “I certify that the answers given by me in this employment application are true, correct and complete. I agree that the company shall not be liable, in and respect, if my employment is terminated because of misstatements or pertinent omissions made by me in this application. Moreover, I understand that all offers of employment are contingent upon passing the company’s prescribed physical examination and drug screen.” “I agree, as a condition of my employment (should II be employed by the company), to submit to a medical examination if requested and based on the position that I accept or urinalysis test if requested and paid for by the company I further agree to the search or examination of myself or personal property while on the company’s premises or while conduction its business elsewhere, I also authorize any company, school, police or security personnel, or other person to give any information regarding my employment, habits, ability, or any other characteristics whatsoever together with any information they have regarding me whether or not it is in their records. I hereby release all physicians, Examiner, companies, schools, or other persons from liability for any damages whatsoever for such testing, examining, or issuing this information. It is agreed and understood that completion of this application does not mean a job opening exists and in no way obligates the company to employ me.’ “In the event of employment, I will comply with all company rules and regulations as established from time to time including the company’s substance abuse policy. I am willing to work all assigned overtime of other special work assignments as requested by the company. Furthermore, since the company does not offer contracts of employment ( unless signed by the President), I understand that nothing contained herein is intended to create a contract between the company and me for either employment or the provision of any compensation or benefits, I understand that I have the right to terminate my employment at any time and likewise, the company has the same right.” “I hereby understand and acknowledge that any employment relationship with this Company is of an “At – Will” nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time, with or without notice, with or without Cause. It is further understood that this “At – Will “ employment relationship may not be changed by any written document or by verbal agreement unless such change is specifically acknowledged in writing by an authorized Executive of this Company. I also understand that Matt's Lawn Care, retains the right to amend, modify , add or delete any or all policies or procedures at its sole and absolute discretion.” “During my employment with Matt's Lawn Care and after my employment ends, I agree not to disclose any confidential or proprietary information regarding operating and trade secrets. I further agree not to work for or affiliate with any Lawn maintenance companies, for two years after my employment ends. I agree that with respect to any civil litigation involving Matt's Lawn Care, in which I am a potential witness and which does not involve an actual or potential claim by me personally, I will not discuss the facts of the case with any third parties without first notifying Matt's Lawn Care, or unless a representative or attorney of Matt's Lawn Care, is present. A copy of this form may be used as the original. The use of results from this form and / or tests will be used for prudent employment decisions.”

Signature: (type name as signature)

Date: