Job Application – Kelly Landscapes Management

Position(s) Applying For *

Check the position or positions you are interested in.

Date of Application *

MM/DD/YYYY

How did you find us? *

Name *

First

Last

Address *

City

State/Province

Zip/Postal Code

Country

Phone *

Email *

When is the best time to contact you?

Mornings
Afternoons
Evenings

(Check all that apply)

If you are under 18 years of age, can you provide required proof of your eligibility to work? *

Have you ever filled out an application with us before? *

If yes, give date

Do any of your friends or relatives, other than spouse, work here? *

If Yes, state name and relationship.

Are you currently employed? *

If yes, may we contact your present employer?

Are you prevented from lawfully becoming employed in this country because of VISA or IMMIGRATION STATUS? *

Date available to work *

MM/DD/YYYY

What is your desired salary range?

Full Time or Part Time? *

Are you currently on "lay-off" status and subject to recall?

Schooling Info *

Education *

What is the highest level of schooling completed?

Employer 1

Employer's Address

City

State/Province

Zip/Postal code

Country

Employer's Phone #

Supervisor's Name

Job Title

Reason For Leaving

Dates of Employment

From __/__/__ To __/__/__

Salary or Hourly Rate

Employer 2

Employer's Address

City

State/Province

Zip/Postal code

Country

Employer's Phone #

Supervisor's Name

Job Title

Reason For Leaving

Dates of Employment

From __/__/__ To __/__/__

Salary or Hourly Rate

Are you a veteran of the U.S. Military Service? *

Have you ever been convicted of a felony? *

If yes, please explain.

I CERTIFY that answers given herein are true and complete to the best of my knowledge. I authorize investigations of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I understand that this application is not intended to be a contract of employment. In the event of employment, I understand that false or misleading information given on my application or interview may result in termination. *

Reference 1 Name *

Address *

City

State/Province

Zip/Postal Code

Country

Phone *

Relationship *

Reference 2 Name *

Address *

City

State/Province

Zip/Postal Code

Country

Phone *

Relationship *

Have you had or do you have any of the following? Abdonimal pain? *

Acquired Immune Deficiency Syndrome (AIDS) *

Alcoholism *

Allergies *

Asthma *

Back Injury *

Bone, joint or other deformity *

Chest or Lung Disease *

Chronic Back Disorder *

Chronic Cough *

Depression *

Dizziness or unconsciousness *

Drug or Narcotic Addiction *

Epilepsy or Convulsions *

Family History of Diabetes *

Hearing Impairment *

High or Low Blood Pressure *

Kidney Disease or Hepatitis *

Kidney Stone or Blood in Urine *

Loss of Memory *

Marked Increase or Decrease in Weight *

Pain or Pressure in Chest *

Palpitation or Heart Disease *

Pleurisy *

Pneumonia *

Rheumatic Fever *

Severe eye, nose or throat trouble *

Shortness of Breath *

Stomach, liver, or intestinal trouble *

Tumor, growth, cyst or cancer *

Tuberculosis *

Have you had any other illness than those listed? *

If yes, give details

Have you been under a doctor's care within the past 5 years *

If yes, give details

Have you ever been hospitalized? *

If yes, give details including hospital and reason

Have you ever been rejected for Life Insurance, Military Service, or Employment? *

If yes, give details

Are you receiving or have you received Workman's Compensation as a result of injury or illness? *

AFFIDAVIT. I declare each of the above answers to be complete and true to the best of my knowledge and I Am AWARE THAT ANY MISREPRESENTATION or omission may be cause for dismissal. I authorize investigation of all statements contained in this application. Also, I waive any provisor of law forbidding any physician who has attended me or hospital where I hereby authorize them to make such disclosures as the Company may request. Further, I understand and agree that my employment is for no definite period and, may regardless of the date of payment of my wages and salary, be terminated at any time without previous notice. *

PRE-EMPLOYMENT DRUG TESTING CONSENT AND RELEASE FORM * I hereby consent to submit to urinalysis and/or other tests as shall be determined by The Company in the selection process of applicants for employment, for the purpose of determining the drug content thereof. I agree that (to be given at time of test) may collect these specimens for these tests and may test them or forward them to a testing laboratory designated by the Company for analysis. I further agree to and hereby authorize the release of the results of said tests to the Company. I understand that it is the current use of illegal drugs that would prohibit me from being employed at this Company. I further agree to hold harmless the Company and its agents (including the above named physician or clinic) from any liability arising in whole or part, out of the collection of specimens, testing, and use of the information from said testing in connection with the Company's consideration of my application of employment. I further agree that a reproduced copy of this pre-employment consent and release form shall have the same force and effect as the original. By checking the box below I declare the I have carefully read the foregoing and fully understand its contents. I also declare that checking the box below is a voluntary act on my part and that I have not been coerced into checking the box by anyone. *

I give consent to being drug tested.

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