The Mulch & Soil Co.

**** ******** ****

Ft. Myers, Florida 33916

239-***-**** • Fax 239-***-****

Application for Employment

The Mulch & Soil Co. is an equal opportunity employer and in compliance with federal and state laws offers job opportunities and advancement to qualified individuals without regard to race, color, religion, national origin, gender, age, marital status, veteran status, and physical or mental disability.

This application is effective for 30 days from the date of this application. If you are still available for employment after that time, you must reapply. Failure to fully complete application may result in non-consideration.

PERSONAL DATA …Please Print or Type…

Last Name First Middle Social Security Number

Present Address Number & Street City State Zip Code # Years

Telephone (with area code) Cell Phone (with area code)

Do you have any relatives or friends presently working for The Mulch & Soil Co.?

o Yes o No If yes, Name: Relationship:

Are you under 18? o Yes o No (If under 18, hire is subject to verification that you are of minimum legal age.)

If hired, can you present evidence of U.S. citizenship or proof of legal right to live and work in this country? o Yes o No

YOUR JOB REQUIREMENTS

Specific position desired: Salary desired: per

How were you referred to The Mulch & Soil Co.?

Check employment schedule desired: o Full-Time o Part-Time o Evenings/Weekends o Summer

Specify hours and days you would be available for work?

The following conditions may occasionally be required at some point in your job assignment. If required, could you work?

Evenings: o Yes o No Overtime: o Yes o No Rotational work schedule: o Yes o No Weekends: o Yes o No

When would you be available to begin work? Do you have reliable transportation to and from work? o Yes o No

Do you understand the physical requirements of the job you are applying for? o Yes o No

Do you have any physical or mental limitations that would affect your ability to perform the duties of this job? o Yes o No

Have you applied for employment with The Mulch & Soil Co. within the last six months? o Yes o No

If yes: When: what Job? Division:

Have you been previously employed by The Mulch & Soil Co. or any of its affiliated companies o Yes o No

If yes, when and for what position or company?

EDUCATION AND TRAINING

Diploma Received Year Graduated/

Name and Location of High School Highest Level Completed Last Year Attended

Name and Location of Trade School, College or University and/or Degree Received? Course of Study or

Other Qualifications of Skills that Make You Especially Suited to This Job (BA, BS, MA, Etc.) College Major

MILITARY RECORD

Branch of Armed Services: Active Duty From: Month Year

To: Month Year

Reserve Status: Branch:

Principle Duties and/Special Training

:

GENERAL (Note: Conviction of a crime is not automatic disqualification. All circumstances will be considered including age at time of

offense, whether first offender conviction, seriousness, and nature of violation and rehabilitation.)

Have you ever been convicted of a misdemeanor, felony, or released from incarceration or probation? o Yes o No

If Yes, fully explain:

SKILLS (Please list all equipment and programs you have experience with; i.e. computer software, calculator, forklift, etc.)

EMPLOYMENT HISTORY (Please list most recent first.)

Company Address/City/State/Zip Telephone (Daytime) Worked From: To:

Supervisor Name Type of Business Position/Duties Pay Starting: Ending:

Company Address/City/State/Zip Telephone (Daytime) Worked From: To:

Supervisor Name Type of Business Position/Duties Pay Starting: Ending:

Company Address/City/State/Zip Telephone (Daytime) Worked From: To:

Supervisor Name Type of Business Position/Duties Pay Starting: Ending:

Personal References Please list three references that are NOT former employers

Name/Occupation Address/City/State/Zip Telephone (Day time #) # of Years Known

Please read the following and sign the bottom of this form.

I hereby certify that I have not knowingly withheld any information that might adversely affect my chances for employment and that the answers given by me are true and correct to the best of my knowledge. I further certify that I, the undersigned applicant, have provided the information on this application. I understand that any omission or misstatement of material fact on this application or on any document used to secure employment shall be grounds for rejection of this application or for immediate discharge if I am employed, regardless of the time elapsed before discovery.

I hereby authorize The Mulch & Soil Co. (the Company) to thoroughly investigate my references, work record, education and other matters related to my suitability for employment and, further, authorize my former employment to disclose to the Company all letters, reports and other information related to my work records, without giving me prior notice of such disclosure. In addition, I hereby release the Company, my former employers and all other persons, corporations, partnerships and associations from any and all claims, demands or liabilities arising out of or in any way related to such investigation or disclosure.

I understand that if I am hired, I will conform to the rules and regulations of the Company. The Company intends to conduct its business with the highest degree of safety and efficiency. Because of this, the Company may require applicants to undergo a physical examination or to undergo Blood/urine screening for drugs. All applicants or employees asked to submit to such testing must have negative results as a condition of continued employment.

I understand that nothing contained in this application or conveyed during any interview which may be granted is intended to create an employment contract between me and the Company. In addition, I understand and agree that if I am employed, my employment is for no defined period and may be terminated at any time, with or without prior notice, at the option of either myself or the Company, and that no promises or representations contrary to the foregoing are binding on the Company unless made in writing and signed by me and the Company’s designated representative.

Date: Applicant’s Signature:

Signature of Interpreter (if applicable):

Date:

NOTICE

DRUG – FREE

WORKPLACE

If you use drugs, do not apply. We test all applicants for drugs prior to hire. All of our employees are subject to periodic drug and alcohol testing.

Contact this candidate