J & M Lawn Care / Landscaping                                      Job Application                                       

PERSONAL INFORMATION:

Date                                                                                                                     Social Security Number                     -                 -                           

Name                                                                                                                                                                                                                                
                               Last                                                                                                             First                                                                                                             Middle

Present Address                                                                                                                                                                                                             
                               Street                                                                                                           City                                                                                      State                                                              Zip

Permanent Address                                                                                                                                                                                                       
                               Street                                                                                                           City                                                                                      State                                                             Zip

Phone No.  (       )                                                                Permanent Phone No.   (       )                                                                                         

Can you provide proof that you can be lawfully employed in the U.S.?    ¨ Yes    ¨ No (Proof of citizenship or immigration status will be required upon employment)

We may check criminal records of applicants.  Does your record include any convictions, guilty pleas, jail, or prison time?                 ¨Yes   ¨No If yes, please explain.
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____________________________________________________________________________________________________________

(A criminal record will not necessarily disqualify applicant from employment.)

Referred by:  ¨Newspaper   ¨Walk-In   ¨School   ¨Friend   ¨Internet  ¨Current Employee (Name)______________                       

Are you now, or do you expect to be engaged in any other business or employment?  ¨ Yes  ¨ No (If yes, please explain.)
 

EMPLOYMENT DESIRED:

Position                                                                               Date you can start                                                             Wage Desired? $                
How many hours per day?                                Per week?                How long do you need employment?                                                                         
Are you employed now?                                   If so, may we inquire of your present employer? ¨ Yes  ¨ No
Please check all you will accept:
                ¨ Full Time                                                                         ¨ Part Time                                                         ¨ Weekends
Do you have reliable transportation?  ¨ Yes  ¨ No
Do you have auto insurance?  ¨ Yes  ¨ No

REFERNCES:  List the names of two people not related to you who you have known for at least one year:

Name                                             Address                                          Telephone Number                                Years Acquainted

________________________________________________________________________________________________________________________

Name                                             Address                                         Telephone Number                                Years Acquainted

________________________________________________________________________________________________________________________

I hereby affirm that the information provided on this application, and accompanying letter or resume is true and complete.  I authorize investigation of all statement contained in this application including contacting past employers regarding work record.  I release and hold harmless and promise not to claim damages from any of my prior employers listed above who have provided information.  I understand that misrepresentation or omission of facts called for is cause for dismissal.  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 any previous notice.  I agree to submit to any drug or alcohol testing that may be required by the employer for my hire or continued employment.  I understand that refusal to take such tests may be cause for denial of employment or termination.  I also understand that employment may be conditional upon an investigation into any criminal conviction on record with local, State, or Federal law enforcement authorities.  I understand this application is not a contract.

                Signature                                                                                                                              Date