Text Box: Application for Employment Name of Applicant: ______________________ Date of Application: _____________________ How did you learn about us? ____________________________________________ What is the position that you are applying for? ________________________________ Personal Information: Home Phone: _______________________Cell Phone: _______________________ Address: __________________________________________________________ How long at present address? ___________________________________________ Email Address (optional): ______________________________________________ Person to Notify in Case of Emergency: Name: ____________________________ Home Phone: _____________________ Cell Phone: __________________ Address: _______________________________ If you are under 18 years of age, can you provide required proof of your eligibility to work? __ Have you ever been convicted of a felony or misdemeanor other than a traffic violation? ____ If so, explain: ______________________________________________________ ________________________________________________________________ List any traffic violations in the last 5 years: __________________________________ ________________________________________________________________ Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status? _________________________________________________ Are you currently employed? ___________________________________________ On what date would you be available for work? _______________________________ Starting Wage desired $____________ per hour Desired hours per week? ______________________________________________ **OVERTIME is sometimes required to complete a project, would that cause a problem for you? Work History (Over the Past 5 Years): 1. Employer: ______________________________________________________ Dates worked: ____________________________________________________ Reason for Leaving: ________________________________________________ 2.Employer: _______________________________________________________ Dates worked: ____________________________________________________ Reason for Leaving: ________________________________________________ 3.Employer: ______________________________________________________ Dates worked: ____________________________________________________ Reason for Leaving: ________________________________________________ References: Name: ______________________________ Phone Number: ________________ Address:_________________________________________________________ Name: ______________________________ Phone Number: _________________ Address: _________________________________________________________ Name: ______________________________ Phone Number: _________________ Address: _________________________________________________________ Medical Problems or Conditions (If Any): __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ Do you have any Physical Conditions or Handicaps that may limit your ability to perform the job applied for? If so, what can be done to accommodate your limitation?: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Experience: Do you have any special skills? (i.e. Carpentry, mechanics, welding, stonewall work, etc.)________________________________________________________________________________________________________________________________________________________________________________________________ Education: College:___________________________________________________________ ________________________________________________________________ Graduate/ Professional/ Trade: __________________________________________ __________________________________________________________________________________ Describe Course of Study: ______________________________________________ ________________________________________________________________ Describe any specialized training, apprenticeship, skills, and extra-curricular activities:____ ________________________________________________________________ ________________________________________________________________ Describe any honors you have received: _____________________________________ ___________________________________________________________________________________ State additional information you feel may be helpful to us in considering your application: By signing this document I verify that all the information written on this application is true, and I understand that false statements or significant omissions may disqualify me from further consideration for employment and may be considered justification for dismissal if discovered at a later date. Applicant’s Signature: __________________________________ Date:__________ Please submit applications to: A.C. Parsons Landscaping & Garden Center P.O. Box 116 Bernard, ME 04612