Home / Employment Application


Name: *
Phone: *
How did you hear about Broccolo Tree and Lawn Care?
If under the age of 18, can you produce the necessary work certificate at the time of employment? Yes No
Are you an U.S. citizen or an alien who has the legal right to remain and work in the US? (You will be required to furnish proof of lawful work status if you are extended a job offer.)
Have you ever been convicted of a crime?
If so, please describe fully the criminal conviction(s) listing the nature of the offence, your rehabilitation since the conviction(s). A conviction record will not necessarily be a bar to employment. New York applicants: All pending arrests or criminal accusations must be disclosed. You are not required to disclose arrests or criminal accusations that resulted in criminal actions or proceedings which were terminated in your favor. Do not disclose criminal actions or proceedings that were sealed or classified as youthful offender adjudications. An ex-offender who is denied employment may, upon written request, receive a statement of the reason(s) for denial within thirty (30) days of the applicant’s request for such information.

Employment Desired

Position(s) Applied For
Date You Can Start
Number of Hours You Can Work ?
Are You Willing to Work Over Time?
Have you ever worked for Broccolo Group Before?

If you have worked with us before.. 

Reason for Leaving?


High School Name & Location (Address, City, State)
Years Attended High School
Date Graduated High School
Number of Years of Completed High School


College School Name & Location (Address, City, State)
Years Attended College
Date Graduated College
Number of Years of Completed College
Degree/ Major

Bus./Tech/Trade School

Bus./Tech/Trade School Name & Location (Address, City, State)
Years Attended Bus./Tech/Trade School
Date Graduated Bus./Tech/Trade School
Number of Years of Completed Bus./Tech/Trade School
Bus./Tech/Trade Degree/ Major

Work Experience

Present / Most Recent Employer

Dates Employed:

Most Recently From:
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Most Recently To:
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Most Recent Company Name:
Most Recent Company Address:
Most Recent Company Nature of Business:
Job Title at Most Recent Company:
Starting Wage at Most Recent Company :
Ending Wage at Most Recent Company:
Major Responsibilities at Most Recent Company:
Supervisor's Name at Most Recent Company:
Supervisor's Job Title at Most Recent Company:
Reason for leaving Most Recent Company:
May We Contact Most Recent Company for a reference?
If no, why not?
What will your employer say was the reason for your leaving, your Most Recent Company ?
How much notice did you give your Most Recent Company prior to resigning?
Most Recent Company-- If none explain

Past Employer 1

Dates Employed:

Past Employer 1-- From:
 /  / 
Past Employer 1-- To:
 /  / 
Past Employer 1-- Company Name:
Past Employer 1-- Company Address:
Past Employer 1-- Nature of Business:
Past Employer 1-- Job Title:
Past Employer 1-- Starting Wage :
Past Employer 1-- Ending Wage:
Past Employer 1-- Major Responsibilities:
Past Employer 1-- Supervisor's Name:
Past Employer 1-- Supervisor's Job Title:
Past Employer 1-- Reason for leaving:
May We Contact Past Employer 1?
Past Employer 1-- If no, why not?
Past Employer 1-- What will your employer say was the reason for your leaving?
Past Employer 1-- How much notice did you give ?
Past Employer 1-- If none explain:

Past Employer 2

Dates Employed:

Past Employer 2-- From:
 /  / 
Past Employer 2-- To:
 /  / 
Past Employer 2-- Company Name:
Past Employer 2-- Company Address:
Past Employer 2-- Nature of Business:
Past Employer 2-- Job Title:
Past Employer 2-- Starting Wage :
Past Employer 2-- Ending Wage:
Past Employer 2-- Major Responsibilities:
Past Employer 2-- Supervisor's Name:
Past Employer 2-- Supervisor's Job Title:
Past Employer 2-- Reason for leaving:
May We Contact Past Employer 2?
Past Employer 2-- If no, why not?
Past Employer 2-- What will your employer say was the reason for your leaving?
Past Employer 2-- How much notice did you give ?
Past Employer 2-- If none explain:

Have you ever been terminated or asked to resign from any job?
If yes, please explain the circumstances of each occasion.


Please list the names of additional personal work-related references we may contact (persons not related to you). Individuals with no prior work experience may list school or volunteer-related references.

Reference 1 Name:
Reference 1 Relationship:
Reference 1 Years Known:
Reference 1 Telephone:
Reference 1 E-mail:

Reference 2 Name:
Reference 2 Relationship:
Reference 2 Years Known:
Reference 2 Telephone:
Reference 2 E-mail:

Reference 3 Name:
Reference 3 Relationship:
Reference 3 Years Known:
Reference 3 Telephone:
Reference 3 E-mail:

Other Information

Do you have a valid State Drivers License?
Please list any driving convictions during the past three years.
List any equipment you can operate other than automobiles:
Do you have a D.E.C Commercial Pesticide Applicators Certification?
If so, category?
Any other industry related certifications?
If so, category of other industy relalated Certifications?

What do you consider to be your best motivator in performing you job duties?
Activities, athletics, community volunteering, hobbies, etc.
Do you have any impairment that would interfere with your ability to perform the job you are applying for?

Applicant Certification:

I understand and agree that if driving is a requirement of the job for which I am applying, my employment and/or continued employment is contingent on possessing a valid driver’s license for the state in which I reside and automobile liability insurance in an amount equal to the minimum required by the state where I reside.

This Company is an At-Will employer as allowed by applicable State Law. This means that regardless of any provision in this application, if hired, the Company or I may terminate the employment relationship at any time, for any reason, with or without cause or notice. Nothing in this application or in any document or statement, written or oral, shall limit the right to terminate employment at-will. No officer employee or representative of the Company is authorized to enter into an agreement – express or implied – with me or any applicant for employment for a specified period of time unless such an agreement is in a written contract signed by the President of the Company.

If hired, I agree to conform to the rules and regulations of the Company, and I understand that the Company has complete discretion to modify such rules and regulations at any time, except that it will not modify its policy of employment at-will.

I authorize the Company or its agents to confirm all statements contained in this application and/or resume as it relates to the position I am seeking and to the extent permitted by federal, state, or local law. I agree to complete any requisite authorization forms for the background investigation.

I have provided truthful and complete responses to all inquiries in the application. I understand that the discovery of any falsification or omission constitutes a ground for immediate dismissal. If hired, I understand that I will be required to provide genuine documentation establishing my identity and eligibility to be legally employed in the United States by this Company. 

Applicant’s Signature: *
Today's Date: *
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