Employment Application

Step 1 of 6 - Basic Information

Basic Information
Name*
First Last
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.)
- Yes
- No
Phone*
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
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
Employment Desired
Position(s) Applied For
Date you can start
MM slash DD slash YYYY
Number of hours you can work
Are you willing to work overtime?
- Yes
- No
Have you ever worked for Broccolo Group Before?
- Yes
- No
If you have worked with us before:
When?
Position?
Reason for leaving?

Work Experience
Present/Most Recent Employer
Dates Employed
Date From
MM slash DD slash YYYY
Date To
MM slash DD slash YYYY
Company Information
Company Name
Company Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Nature of Business
Job Title
Starting Wage
Ending Wage
Major Responsibilities
Supervisor's Name
Supervisor's Job Title
Reason for Leaving
May we contact most recent company for a reference?
- Yes
- No
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 prior to resigning?
If you do not have a present/most recent employer, please explain.
Past Employer 1
Dates Employed
Date From
MM slash DD slash YYYY
Date To
MM slash DD slash YYYY
Past Employer 1 Company Information
Company Name
Company Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Nature of Business
Job Title
Starting Wage
Ending Wage
Major Responsibilities
Supervisor's Name
Supervisor's Job Title
Reason for Leaving
May we contact Past Employer 1 for a reference?
- Yes
- No
If no, why not?
What will your employer say was the reason for your leaving?
How much notice did you give prior to resigning?
If none, explain:
Past Employer 2
Dates Employed
Date From
MM slash DD slash YYYY
Date To
MM slash DD slash YYYY
Past Employer 2 Company Information
Company Name
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Nature of Business
Job Title
Starting Wage
Ending Wage
Major Responsibilities
Supervisor's Name
Supervisor's Job Title
Reason for Leaving
May we contact Past Employer 2 for a reference?
- Yes
- No
If no, why not?
What will your employer say was the reason for your leaving?
How much notice did you give?
If none, explain:
Have you ever been terminated or asked to resign from any job?
- Yes
- No
If yes, explain the circumstances of each occasion.

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*
MM slash DD slash YYYY
Verification

59631

Name	Relationship	Years Known	Telephone	Email

Employment Application

Step 1 of 6 - Basic Information

Basic Information

Employment Desired

Education

High School

College

Bus./Tech/Trade School

Work Experience

Present/Most Recent Employer

Dates Employed

Company Information

Past Employer 1

Dates Employed

Past Employer 1 Company Information

Past Employer 2

Dates Employed

Past Employer 2 Company Information

References

Other Information

Applicant Certification

Years Attended	Date Graduated	Years Completed

Years Attended	Date Graduated	Years Completed

Years Attended	Date Graduated	Years Completed