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322 N. Eason Blvd.
Tupelo, MS 38804
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Position(s) applied for
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Type of employment desired
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Have you ever pled “guilty” or “no contest” to, or been convicted of, a crime?
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If Yes, please provide date(s) and details:
Answering “Yes” to these questions does not constitute an automatic bar to employment. Factors such as date of the offense, seriousness and nature of the violation, rehabilitation, and position applied for will be taken into account.
Do you have a valid driver's license?
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What state is it in?
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
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Florida
Georgia
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Hawaii
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Employment History
Provide the following information for your past three (3) employers, assignments, or volunteer activities, starting with the most recent.
Start Date
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End Date
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Employer
Phone
Starting Job Title
Final Job Title
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Immediate Supervisor and Title:
First
Last
Title
Summary of Work Performed and Job Responsibilities:
May we contact for reference?
Yes
No
Later
Reason for Leaving:
Starting Rate/Salary:
Final Rate/Salary:
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Employer
Phone
Starting Job Title
Final Job Title
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Immediate Supervisor and Title:
First
Last
Title
Summary of Work Performed and Job Responsibilities:
May we contact for reference?
Yes
No
Later
Reason for Leaving:
Starting Rate/Salary:
Final Rate/Salary:
Start Date
MM slash DD slash YYYY
End Date
MM slash DD slash YYYY
Employer
Phone
Starting Job Title
Final Job Title
Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Immediate Supervisor and Title:
First
Last
Title
Summary of Work Performed and Job Responsibilities:
May we contact for reference?
Yes
No
Later
Reason for Leaving:
Starting Rate/Salary:
Final Rate/Salary:
Skills and Qualifications
Summarize any training, skills, licenses, and/or certificates that may qualify you as being able to perform job-related functions in the position for which you are applying.
Educational Background
(if job related)
Highschool
Did you graduate?
Yes
No
College
Did you graduate?
Yes
No
Major
Other
References
Name
First
Last
Phone
Number of Years Known
Name
First
Last
Phone
Number of Years Known
Name
First
Last
Phone
Number of Years Known
Can you pass a drug test, if necessary?
Yes
No
Do you have any Landscape work history?
Yes
No
If yes, where?
What has been your favorite job? What did you do at that job?
Can you deal with Summer Heat?
Yes
No
How is/ Can you provide a driving record?
Do you consider yourself a detailed oriented person?
Yes
No
Why do you want to work for Sportsman Lawn and Landscape?
I certify that all information I have provided to apply for and secure work with the employer is true, complete, and correct. I understand that any information provided by me that is found to be false, incomplete, or misrepresented in any respect, will be sufficient cause to (i) cancel further consideration of this application or (ii) immediately discharge me from the employer’s service, whenever it is discovered. I expressly authorize, without reservation, the employer, its representatives, employees, or agents to contact and obtain information from all references (personal and professional), employers, public agencies, licensing authorities, and educational institutions and to otherwise verify the accuracy of all information provided by me in this application, resume, or job interview. I hereby waive any and all rights and claims I may have regarding the employer, its agents, employees, or representatives for seeking, gathering, and using such information in the employment process and all other persons, corporations, or organizations for furnishing such information about me. I understand that the employer does not unlawfully discriminate in employment, and no question on this application is used for the purpose of limiting or excusing any applicant from consideration for employment on a basis prohibited by applicable local, state, or federal law. I understand that this application remains current for only 30 days. At the conclusion of that time, if I have not heard from the employer and still wish to be considered for employment, it will be necessary to reapply and fill out a new application. If I am hired, I understand that I am free to resign at any time, with or without cause and without prior notice, and the employer reserves the same right to terminate my employment at any time, with or without cause and without prior notice, except as may be required by law. This application does not constitute an agreement or contract for employment for any specified period or definite duration. I understand that no supervisor or representative of the employer is authorized to make any assurances to the contrary and that no implied, oral, or written agreements contrary to the foregoing express language are valid unless they are in writing and signed by the employer’s president. I also understand that if I am hired I will be required to provide proof of identity and legal authority to work in the United States and that federal immigration laws require me to complete an I-9 Form in this regard.
Do not sign until you have read the above applicant statement.
I certify that I have read, fully understand, and accept all terms of the foregoing Applicant Statement.
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