5112 W Ridge Rd.
Spencerport, NY 14559

Application For Employment

Cardinal Lawn and Landscape is committed to the employment and advancement of minorities, females, individuals with disabilities, and veterans. If you fall into one of these protected classifications, we invite you to identify to yourself and receive coverage under our company’s Affirmative Action Plan. You may inform us of your desire to benefit under the program at this time and/or any time in the future.


Completion of this form is voluntary and in no way affects the decision regarding your employment opportunity. The information provided will be held in the strictest confidence, will be maintained in a separate file, and will not be used in a manner inconsistent with the Acts.


Choose one race/ethnic group. Submission of information is voluntary.
Hispanic or Latino  White  Black or African American Native Hawaiian or Other Pacific Islander  Asian American Indian or Alaska Native  Two or more races

Definitions

Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race. White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa. Black or African American (Not Hispanic or Latino) – A person having origins in any of the black racial groups of Africa. Native Hawaiian or Other Pacific Islander (Not Hispanic or Latino) – A person having origins in any of the peoples of Hawaii, Guam, Samoa, or other Pacific Islands. Asian (Not Hispanic or Latino) – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent, including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam. American Indian or Alaska Native (Not Hispanic or Latino) – A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. Two or More Races (Not Hispanic or Latino) – All persons who identify with more than one of the above five races.
APPLICANT'S PERSONAL DATA
Have you previously been employed by Cardinal Lawn and Landscape? YesNo
When?  Position?
When?  Position?
APPLICANT'S EMPLOYMENT DATA
Date available for work:
If hired, will you be able to work the scheduled days and hours required, which may include daily and weekly overtime? YesNo
Minimum salary requirement: $
How were you referred to Cardinal Lawn and Landscape?
May we contact you at work?Yes  No
Business Telephone
APPLICANT'S GENERAL INFORMATION
If yes, which name?
If yes, which employer?
Have you been convicted of a felony involving a crime of violence, theft or breach of trust? YesNo If yes, please explain:
APPLICANT'S WORK HISTORY
Start with your most recent position. If you have worked for any company as a temporary/contract employee, please specify that clearly under the appropriate employer, making sure to include the agency’s name and telephone number. Give accurate summaries of your duties, concentrating on major aspects of the position including number of personnel supervised, financial responsibilities and major accomplishments. Periods of unemployment should also be noted. Leave no gaps in time sequence.
Employer 1
From:
To:
Starting Job Title
Present (or last) Job Title
City, State
Immediate Supervisor's Name
Supervisor's Job Title
Telephone
Rate of Pay
Reason for Leaving
Summarize Job Responsibilities and Duties
May we contact this employer? YesNo
Employer 2
From:
To:
Starting Job Title
Present (or last) Job Title
City, State
Immediate Supervisor's Name
Supervisor's Job Title
Telephone
Rate of Pay
Reason for Leaving
Summarize Job Responsibilities and Duties
May we contact this employer? YesNo
Employer 3
From:
To:
Starting Job Title
Present (or last) Job Title
City, State
Immediate Supervisor's Name
Supervisor's Job Title
Telephone
Rate of Pay
Reason for Leaving
Summarize Job Responsibilities and Duties
May we contact this employer? YesNo
APPLICANT'S EDUCATION
Name of School(No Abbreviations) LocationCity/State Dates ofAttendance HighestGradeCompleted Diploma/DegreeAcquired
High School
College
Vocational/Technical
Other
APPLICANT'S U.S. MILITARY SERVICES HISTORY
Branch of Services Technical Specialization Rank Attained
APPLICANT'S REFERENCES

Please provide the names and contact information for three personal and professional references:

Name: Relationship: Contact Information: Telephone:
Name: Relationship: Contact Information: Telephone:
Name: Relationship: Contact Information: Telephone:

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