Applicant InformationFirst Name(Required) Last Name(Required) M.I. Address(Required) Street Address Apartment/Unit # City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Date Available MM slash DD slash YYYY Position Applied for: Hourly rate/Salary desired: Are you authorized to work in the U.S. Yes No Are you currently employed? Yes No Have you ever been terminated from employment? Yes No If you responded yes, why? What days are you available to work?(Required) Are you able to work overtime, evenings, or weekends?(Required) Are you able to bend, kneel, & lift up to 50 lbs.? Yes No Are you able to perform the essential functions of the job for which you are applying, with or without reasonable accommodations? Yes No Have you ever worked for this company? Yes No How did you hear about us? ResumeAccepted file types: pdf, doc, docx, txt, rtf, Max. file size: 10 MB.Please fill out the application below or submit your resume here.Previous EmploymentEmployer #1Name Address PhoneSupervisor Job Title ResponsibilitiesStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Reason for Leaving Rate of final pay May we contact your previous supervisor for a reference? Yes No Employer #2Name Address PhoneSupervisor Job Title ResponsibilitiesStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Reason for Leaving Rate of final pay May we contact your previous supervisor for a reference? Yes No Employer#3Name Address PhoneSupervisor Job Title ResponsibilitiesStart Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Reason for Leaving Rate of final pay May we contact your previous supervisor for a reference? Yes No EducationHigh SchoolName Address Did you graduate? Yes No CollegeName Address Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Did you graduate? Yes No Other EducationName Address Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Did you graduate? Yes No ReferencesPlease list three professional referencesReference #1Full Name Relationship Company PhoneAddress Reference #2Full Name Relationship Company PhoneAddress Military ServiceBranch Start Date MM slash DD slash YYYY End Date MM slash DD slash YYYY Rank at Discharge Type of Discharge If other than honorable, explainAdditional InformationPlease provide any additional information or certifications pertinent to this position.All applicants are considered for all positions without regard to race, religion, color, sex, gender, sexual orientation, pregnancy, age, national origin, ancestry, physical or mental disability, medical condition, military or veteran status, genetic information, marital status, ethnicity, citizenship or immigration status or any other protected classification, in accordance with applicable federal, state, and local laws. By completing this application, you are seeking to join a team of hardworking professionals dedicated to consistently delivering outstanding service to our customers and contributing to the financial success of the organization, its clients, and its employees. Equal access to programs, services, and employment is available to all qualified persons. Those applicants requiring accommodation to complete the application and/or interview process should contact a management representative. Please print.Please read carefully before signing: I understand that neither the completion of this application nor any other part of my consideration for employment establishes any obligation for Pleasant View Gardens to hire me. If I am hired, I understand that either Pleasant View Gardens or I can terminate employment at any time for any reason, with or without cause and without prior notice. I understand that no represenatative of Pleasant View Gardens has the authority to make an assurance to the contrary. I attest with my signature below that I ahve given to Pleasant View Gardens true and complete information on this application. No requested information has been concealed. I authorize Pleasant View Gardens to contact references provided for employment reference checks. If any information I provide is untrue, or if I have concealed information, I understand this this will constitute cause for the denial of employment or immediate dismissal.Applicant Statement and AgreementRead and initial each paragraph below. If there is anything that you do not understand, please ask.Digital Signature(Required) Date(Required) MM slash DD slash YYYY Email Δ
