PO Box 772
Wirtz, VA 24184

Application for Employment

Last Name: *
First Name:*
M.I.
Date *
E-mail *
Date of Birth *
Primary Phone *
Primary Phone Type: *
Drivers License # *
State Issued
Street Address *
Apartment/Unit #
City *
State *
Zip *
Employment Objective:

Education

Name of School *
Location of School *
* Did you graduate high school or do you have a high school equivalency diploma?
(If No:) Highest Grade completed?
Number of years of post-high school education:
Name of Institution
Location
Type of Diploma/Degree/Cert
Major/Specialty
Name of Institution
Location
Type of Diploma/Degree/Cert
Major/Specialty
Name of Institution
Location
Type of Diploma/Degree/Cert
Major/Specialty

Experience

Please list landscaping experience first.

Experience #1

Experience #2

Experience #3

Experience #4

Experience #5

Experience #6


References

List names, addresses, and relationships of three persons not related to you who know your professional qualifications. (These references are not a substitute for work related references.)

Full Name
Address
Phone
Relationship

Miscellaneous

*Have you ever been convicted of or plead guilty to a felony?
Please Explain:


I hereby certify that all entries given in this application are true and complete, and I agree and understand that any falsifications of information herein, regardless of time of discovery, may cause forfeiture of my part of any employment in the service of McKinney Landscaping, I understand that all information on this application is subject to verification.
Applicant Signature *
Date: *