Online Application – Caretaker Landscape

Position Applying For

Name

Address

City

State

Zip Code

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Home Number

Best Contact #

Email

Are you legally eligible for employment in the U.S.?

Yes
No

(If hired, you will be required to furnish proof of your eligibility to work in the U.S.)

Are you 18 years of age or older? (Driving jobs require 21 years of age or older)

Yes
No

(If you are hired, you may be required to submit proof of age)

Do you have a valid driver's license and acceptable motor vehicle record? All drivers are subject to Motor Vehicle Review

Yes
No

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Have you had your driver’s license suspended or revoked in the last 3 years?

Yes
No

Give details about suspension or revocation

Have you ever applied here before?

Yes
No

Date of Previous Application

Were you ever employed here?

Yes
No

Date of Previous Employment

Have you ever worked for Caretaker through a staffing agency?

Yes
No

Name of Agency

If yes, list date worked

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Have you worked or attended school under any other names?

Yes
No

Education

Please list your highest level of education and name of school

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High School - Years Completed

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High School - Field of Study

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High School - Graduate or Degree

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College/University - Years Completed

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College/University - Field of Study

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College/University - Graduate or Degree

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Business/Technical - Years Completed

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Business/Technical - Field of Study

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Business/Technical - Graduate or Degree

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Other - Years Completed

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Other - Field of Study

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Other - Graduate or Degree

Give other names used

Work History

List names of employers in consecutive order, with present or most-recent employer listed first, Account for all periods of time, including military service and any periods of unemployment. If self-employed, give firm name and related business references. Note: A job offer may be contingent upon acceptable references from current and former employers.

Attach Resume, if applicable

Accepted file types: doc, docx, gif, jpg, pdf, png, Max. file size: 50 MB.

LIST AT LEAST ONE EMPLOYER BELOW

No work history? CHECK THE BOX BELOW.

WORK HISTORY

I have no work history.

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Employer 1 - Name of Company

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Employer 1 - Address

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Employer 1 - City, State, Zip Code

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Employer 1 - Supervisor(s)/Telephone

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Employer 1 - Job Title and Duties

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Employer 1 Date Employment Start

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Employer 1 Date Employment End

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Employer 1 - Reason for Leaving

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Employer 2 - Name of Company

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Employer 2 - Address

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Employer 2 - City, State, Zip Code

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Employer 2 - Supervisor(s)/Telephone

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Employer 2 - Job Title and Duties

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Employer 2 Date Employment Start

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Employer 2 Date Employment End

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Employer 2 - Reason for Leaving

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Employer 3 - Name of Company

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Employer 3 - Address

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Employer 3 - City, State, Zip Code

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Employer 3 - Supervisor(s)/Telephone

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Employer 3 - Job Title and Duties

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Employer 3 Date Employment Start

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Employer 3 Date Employment End

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Employer 2 - Reason for Leaving

Employer 1

Name of Employer

Supervisor Name

Supervisor Phone #

Supervisor Email

City & State

Job Title & Duties

Start Date

End Date

Reason for Leaving

Employer 2

Name of Employer

Supervisor Name

Supervisor Phone #

Supervisor Email

City & State

Job Title & Duties

Start Date

End Date

Reason for Leaving

Employer 3

Name of Employer

Supervisor Name

Supervisor Phone #

Supervisor Email

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Employer 4 - Address

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Employer 4 - Address

City & State

Job Title & Duties

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Employer 4 - Job Title and Duties

Start Date

End Date

Reason for Leaving

References

Give three references, not relatives or friends, unless a direct supervisor

Reference 1 - Name

Email

Phone

Reference 2 - Name

Email

Phone

Reference 3 - Name

Email

Phone

Additional Information

List any skills relevant to the position you are applying for, including clerical, supervisory or other languages spoken

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Additional Skills including supervision skills, other languages, or information regarding the career/occupation you wish to bring to the employer’s attention.

List your professional licenses, certifications or registrations

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List any professional licenses, certifications or registrations

Today's Date

Applicant Signature - please type full name. This confirms the above information is true and accurate

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