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 Number*Do you have a valid driver’s license?*YesNoLicense #*State*Exp. Date* Commercial Drivers License?*YesNoType?Social Security #*Are you eligible for employment in this country?*YesNoAre you at least 18?*YesNoEmail 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?*YesNoEDUCATION HISTORYSchool nameLocation(city, state)Major courseor subjectDates attendedFrom ToGraduatedYes NoDegreeHigh school YesNoTechnical/trade (after high school) YesNoCollege (list all attended) YesNoOther education/training YesNoEmployment 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 number*Brief description of job duties*City*State*ZIP code*Supervisor’s namePhone number*Base salaryDates worked From* To* Reason for leaving*Last or present companyJob TitleStreet addressPhone numberBrief description of job dutiesCityStateZIP codeSupervisor’s namePhone numberBase salaryDates worked From To Reason for leavingLast or present companyJob TitleStreet addressPhone numberBrief description of job dutiesCityStateZIP codeSupervisor’s namePhone numberBase salaryDates worked From To 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 workTypingYesNoWords per minute:DictationYesNoWords per minute:Computer skills Hardware Software Served apprenticeship?YesNoType:EQUIPMENT EXPERIENCETo be completed by applicant for supervisor/crew workType of machines operatedYears experienceList other shop/production skills not listed above, if any.Type of Equipment OperatedYears of ExperienceMilitary RecordBranch of serviceFrom To Present military affiliation:NoneReserve (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?*YesNoIf 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?YesNoDescribe:PROFESSIONAL/WORK REFERENCES NameTitle/relationshipAddress (street, city, state, ZIP code)Phone no. (include are code)Occupation*****May we contact your present employer?YesNoI 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 Signature
