Sprigs & Twigs Landscapes, LLC

Sprigs & Twigs Inc.
8 Hurlbutt Road
P.O. Box 245
Gales Ferry, CT 06335
Ph: 860-235-0752

Employment Application

Name:*

Address1:*

Address2:    Apartment#:

City:*           State:*    Zip:*

Phone:*        Email:*

Are you legally permitted to be employed in the U.S.?  YesNo
(If offered employment, you will, as a condition of employment, be required to provide proof of identity and legal right to work in the U.S.)

* Required Field

Referral Source

Ad
Recruitment
Friend
Relative (Name if employee of Sprigs & Twigs, Inc)
Other (Describe)

Position Applied For:

Salary Requirements/Expectations (Do not leave Blank or say "Negotiable"):

Personal Information
School most recently attended:

Location:

Last Grade Completed    Grade Point Average:

Did you receive a degree? YesNo   If yes, what degree?

Other education (Trade school, etc.)

During the past 7 years, have you been convicted of a crime other than misdemeanors and traffic violations?
YesNo   If Yes, explain briefly:


(An affirmative answer to this question may not necessarily disqualify you from employment. Each circumstance will be weighed and considered in relationship to the position for which you are applying.)

Emergency Contact:    Contact Phone:

Do you presently have a driver's license?YesNo       Do you presently have a valid CDL?YesNo
(Possession of a current and valid driver’s license is required for positions which include driving in the course of work.)

Number:    State:    Type:    Expiration Date:

Have you ever had a DUI? YesNo   If yes, date:

Have you had a traffic citation with the last 3 years? YesNo
If yes, describe:

Employment History
List name of last two (2) employers:

Employer 1
Business Name:

               From:      Until:

Name and title of last supervisor:    Phone:

Location:

Reason for leaving:

What was your starting rate of pay:      Ending rate of pay:

Employer 2
Business Name:

               From:      Until:

Name and title of last supervisor:    Phone:

Location:

Reason for leaving:

What was your starting rate of pay:      Ending rate of pay:

Qualifications and Skills
Mark on list below work in which you are qualified. Indicate amount of time you have practiced the skill:

Landscape Design		Tree Climbing
Administrative		Landscape Installation
Tree Ground Crew		Horticulture
Landscape Maintenance		Lawn Care
Drainage/Erosion Control		Arborist
Equipment Operator		Other

Essential Functions
Ability to perform the following tasks is required for some positions at Sprigs & Twigs, Inc.

(Please answer all questions in this section)

From: Sit 1 hour daily?	YesNo
From: Stand 8 hours daily?	YesNo
Walk 8 hours daily?	YesNo
Lift 2 hour daily?	YesNo
Push/pull 4 hours daily?	YesNo
Bend/stoop 4 hours daily?	YesNo
Lift/Carry 0-50 pounds frequently?	YesNo
Lift/Carry 51-100 pounds occasionally?	YesNo
Push/pull 35-50 pounds frequently?	YesNo
Push/pull 51-100 pounds occasionally?	YesNo
Make repetitive movements frequently with the left and right hand, wrist, ankle, knee?	YesNo
Twist/turn the trunk of the body frequently?	YesNo
Frequently bend/stoop, push/pull, and step up/down?	YesNo
Occasionally squat, crawl, climb, reach overhead, crouch, kneel & balance?	YesNo
Work on unprotected heights (working from a ladder)?	YesNo
Work around moving machinery?	YesNo
Work in changes of temperature and humidity?	YesNo
Perform close vision work using a computer monitor for 1-3 hours daily? (If applicable)	YesNo
Other:	YesNo

Please note: there may be additional functions essential to the specific job for which you are applying. A job description is available upon request.

Tell us a little about yourself. Why do you think you would be the ideal person for this job?

A CONDITION OF HIRE IS PASSING COMPANY POST-OFFER/PRE-EMPLOYMENT DRUG SCREENING.

I certify that the information contained in this application is correct to the best of my knowledge and understand that deliberate falsification of this information is grounds for dismissal in accordance with Sprigs & Twigs, Inc policy. I authorize the former employers listed above to give you any and all information concerning my previous employment and any pertinent information they may have, personal or otherwise, and release all parties from all liability for any damage that may result from furnishing same to you.

Sprigs & Twigs, Inc is an equal opportunity employer. It is our policy to comply fully with all applicable federal, state and local laws prohibiting discrimination on the basis of race, religion, sex or national origin, age (over 40) or any other basis provided by such laws. Information requested on this application will not be used for any purpose prohibited by law.

Sprigs & Twigs, Inc is an at-will employer, the employer or employee can terminate employment at any time for any reason or no reason.

Check to verify that you have read the Hire conditional Statement.