Family Land Scaping inc
P.O. Box 2634
Bangor, ME 04402
Employment Application   

Applicant Information
Last Name First M.I. Date
Street Address Apartment/Unit #
City State ZIP
Phone E-mail Address
Date Available Social Security No. Desired Salary
Position Applied for
Are you a citizen of the United States? YES NO If no, are you authorized to work in the U.S.? YES NO
Have you ever worked for this company? YES NO If so, when?
Have you ever been convicted of a felony? YES NO If yes, explain

Education

High School Address
From To Did you graduate? YES NO Degree
College Address
From To Did you graduate? YES NO Degree
Other Address
From To Did you graduate? YES NO Degree

References

Please list three professional references.
Full Name Relationship
Company Phone
Address
Full Name Relationship
Company Phone
Address
Full Name Relationship
Company Phone
Address

Previous Employment

Company Phone
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Company Phone
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO
Company Phone
Address Supervisor
Job Title Starting Salary $ Ending Salary $
Responsibilities
From To Reason for Leaving
May we contact your previous supervisor for a reference? YES NO

Military Service

Branch From To
Rank at Discharge Type of Discharge
If other than honorable, explain

Disclaimer and Signature

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview
may result in my release.
Signature
Date