Application For Employment
Perf-a-Lawn, Inc.
Name: (First)
(Middle)
(Last)
Address:
City:
State:
Zip:
Phone:
   
Are you a U.S. Citizen?
Yes
No
Social Security Number:
Any people you know currently or previously employed by us?  
Name/Relationship:  
Name/Relationship:  
Driver License Number: Expires:
Do you own a car? Yes No
Who is it insured by?
Can you drive a manual transmission? Yes No
How many years have you been driving? When was your last accident? Last Violation?
How many accidents have you been involved with in the past 5 years: At Fault? Not At Fault?
Have you ever filed a Workman's Compensation Claim?

Education
Highest Level Completed

List your places of employment for the past 5 years. (Starting with most recent)
Company name or Employer: Supervisor:
City: State:
From: To:
Phone: Duties:
Pay Rate: Reason for Leaving:
Company name or Employer: Supervisor:
City: State:
From: To:
Phone: Duties:
Pay Rate: Reason for Leaving:
Company name or Employer: Supervisor:
City: State:
From: To:
Phone: Duties:
Pay Rate: Reason for Leaving:

"I Certify that the facts contained in this application are true and complete to the best of my knowledge, and understand that. If employed, falsifying statements on this application shall be grounds for dismissal.

I authorize investigation of all statements contained herein and the references and employers listed above to give you any and all information concerning my previous employment and pertinent information they may have, personal or otherwise, and release the company from all liability or damage that may result from utilization of such information.

This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws."

By Submitting this form, you are agreeing to the statements outlined above.