Employment Test Please visit this page on a laptop/desktop computer to complete your application. Personal DataLast Name First Name M.I. Street address Unit/Apt./Lot. # City State ZIP Phone NumberDo you have a valid driver’s license? Yes No License # State Exp. Date MM slash DD slash YYYY Commercial Drivers License? Yes No Type? Social Security # Are you eligible for employment in this country? Yes No Are you at least 18? Yes No Email Address APPLICATION / EMPLOYMENT STATUSDate of Application: List any prior dates of employment and positions with Topeka Landscape: List position and/or type of work for which you are applying: If referred to Topeka Landscape, who provided the recommendation? Type of employment desired: Full-Time Part-Time Seasonal Temporary Date available for work: What is your desired salary or rate of pay? Are you available to work overtime, if necessary? Yes No EDUCATION HISTORYSchool name Location (city, state)Major course or subjectDates attended From ToGraduated Yes NoDegree High school MM slash DD slash YYYY MM slash DD slash YYYY Yes No Technical/trade (after high school) MM slash DD slash YYYY MM slash DD slash YYYY Yes No College (list all attended) MM slash DD slash YYYY MM slash DD slash YYYY Yes No Other education/training MM slash DD slash YYYY MM slash DD slash YYYY Yes No Employment Record Starting with present or most recent, list all previous employers; include self-employment and summer and part-time jobs. If more space is required, please continue on a separate sheet. You may attach a resume, but complete this application as well. Last or present company Job Title Street address Phone numberBrief description of job dutiesCity State ZIP code Supervisor’s name Phone numberBase salary Dates worked From MM slash DD slash YYYY To MM slash DD slash YYYY Reason for leavingLast or present company Job Title Street address Phone numberBrief description of job dutiesCity State ZIP code Supervisor’s name Phone numberBase salary Dates worked From MM slash DD slash YYYY To MM slash DD slash YYYY Reason for leavingLast or present company Job Title Street address Phone numberBrief description of job dutiesCity State ZIP code Supervisor’s name Phone numberBase salary Dates worked From MM slash DD slash YYYY To MM slash DD slash YYYY Reason for leavingPERIODS OF UNEMPLOYMENTPlease use this space to provide details regarding any periods of unemployment (list dates and explanations):OTHER SKILLS AND QUALIFICATIONSDescribe any other skills or qualifications you would bring to Topeka Landscape if you were hired. Please list any tools you have experience using.OUTSIDE ACTIVITIES(Exclude those indicating race, color, religion, sex, national origin, age, or handicap.)Professional memberships, certificates, or licenses heldPast and present civic or cultural activities — include offices heldPrincipal hobbiesSPECIAL SKILLSTo be completed by applicant for office/clerical/supervisor work Typing Yes No Words per minute: Dictation Yes No Words per minute: Computer skills Hardware Software Served apprenticeship? Yes No Type: EQUIPMENT EXPERIENCETo be completed by applicant for supervisor/crew work Type of machines operated Years experience List other shop/production skills not listed above, if any. Type of Equipment Operated Years of Experience Military RecordBranch of service From MM slash DD slash YYYY To MM slash DD slash YYYY Present military affiliation: None Reserve (active) Reserve (inactive) Kinds of training and duty while in service: Criminal Record Note: A criminal record or conviction will not disqualify you from consideration for employment. However, you will not be considered if fail to truthfully complete this selection.Have you ever been convicted of a crime? Yes No If yes, list date(s) and nature of offence(s): Name and location of court: Disposition of case: Name / Number of probation / parole officer: Are there any felony or misdemeanor charges pending against you? Yes No Describe:PROFESSIONAL/WORK REFERENCES Name Title/relationship Address (street, city, state, ZIP code) Phone no. (include are code)Occupation May we contact your present employer? Yes No I hereby certify that the answers and other information on this application are true and correct and that I understand any misrepresentation or omission of facts on my part will be justification for separation from the company’s service, if employed. I understand that my employment may be contingent upon receipt of an alien registration number, verification of birth, and any other pertinent information bearing upon my employment, and that my continued employment depends upon the will of the company or myself. Date MM slash DD slash YYYY Signature