Connelly Lawn & Garden “Serving Western Berks since 1990” 703 Henry Circle Sinking Spring, Pa 19608 Phone: 610-678-8949 Connellylawn@Comcast.net

Application for Employment Personal Information Name_______________________________________ Social Security #_________________________

Current Address (Street) _____________________________________________________________

(City, State, Zip) _____________________________________________________________

Home Phone # _______________________________ Best time to call __________________________

Alternate/Cell Phone # _________________________ E-mail: _________________________________

Are you 18 years or older? Yes No Date of Birth_____________________________

Last year of education 9 10 11 12 College 1 2 3 4

School District __________________________________ College_________________________________

Graduation year _________________________________ Major/Degree:____________________________ Do you have any physical impairments or injuries that would hinder you in doing this job? Yes No Are you a current or past member of the U. S. Military? Yes No Are you a U.S. citizen or an alien authorized to work in the United States? Yes No Do you have reliable transportation? Yes No Are you available to work on weekends? Yes No Can you consistently show up for work on time? Yes No Are you available to work past 5:00 P.M.? Yes No Would you object to a drug test while on the job? Yes No Are you currently employed? Yes No Do you have a current valid Pennsylvania driver’s license? Yes No Pa License #______________ Have you ever been ticketed for a moving violation within the past 5 years? Yes No If yes what was the violation? ______________________________________________________ ______________________________________________________ Have you ever been convicted of a felony Yes No If yes what were the circumstances?______________________________________________________ ______________________________________________________ ______________________________________________________ Employment History List your three previous employers, your supervisor, dates of employment, your starting and ending wages, and the reason for leaving the job. Employer Supervisors Name Start/End Dates Start/End Wages Reason for leaving __________________________________________________________________________________________________________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________

Personal References (list three) Name Address or phone number Relationship

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___________________________________________________________________________ Position Desired: Landscape Crew Lawn Care Crew Other____________________ Date you can start:____________________ Wage Desired:__________________________________ Do you have experience with the following equipment? Check if yes. Mechanical/engine repair _____ Equipment maintenance _____ Push lawnmower _____ Walk behind deck mower _____ Riding mower/tractor _____ Zero turn lawnmower _____ String trimmer _____ Trimmer w/ brushblade _____ Backpack leafblower _____ Walkbehind blower _____ Hedgetrimmer _____ Chainsaw _____ Thatcher _____ Aereator _____ Rototiller _____ Stumpgrinder _____ Brush chipper _____ Fertilizer Spreader _____ Cutoff saw _____ Pole pruners _____ In your past work experience, have you ever done the following? Cut lawns _____ Mulched flowerbeds _____ Trimmed shrubs _____ Pruned shrubs _____ Pruned trees _____ Planted annuals/perennials _____ Planted shrubs _____ Planted trees _____ Build Patios _____ Build retaining walls _____ Aerated a lawn _____ Thatched a lawn _____ Seeded a lawn _____ Lay sod on a lawn _____ Leaf clean-up _____ Climb ladders _____ Applied fertilizers/pesticides _____ Additional job related experience:

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In case of emergency notify _________________________________________Phone number__________________ Connelly Lawn & Garden – is an employment-at-will employer and can terminate employment at any time with or without just cause. Connelly Lawn & Garden reserves the right to change employees’ compensation at any time, for any reason. Connelly Lawn & Garden reserves the right to change the terms and conditions of employees’ employment at any time. I’ve read, understand and agree to abide by the terms set forth in the employee guidelines. Date__________________________ Signature_____________________________________