Anthony Poehlmann, Owner
PLL.Columbia@gmail.com
(573) 819-3851
Employment Application
Applicant Information
Full
Name:
Date:
Last
First
Middle name
Address:
Street Address
Apartment/Unit #
City
Phone:
Date
Available:
(
)
State
ZIP Code
Desired
Salary:
$
E-mail Address:
Social Security
No.:
Position Applied for:
Are you a citizen of the United
States?
Possess valid driver’s license with a
clean record?
Have you ever been convicted of a
felony?
Can repeatedly lift, push, pull, drag
80 pounds/work in extreme climates?
YES
NO
YES
NO
YES
NO
YES
NO
YES
If no, are you authorized to work in the U.S.?
If not, please
explain
If yes, explain:
If not, please explain
Education
High
School:
From:
YES
To:
City:
Did you
graduate?
YES
To:
City:
Did you
graduate?
YES
To:
City:
Did you
graduate?
College:
From:
Other:
From:
NO
Degree:
NO
Degree:
NO
Degree:
References
Please list three professional references.
Full
Name:
Relationship:
Company:
Phone:
(
)
Phone:
(
)
Phone:
(
)
Address:
Full
Name:
Relationship:
Company:
Address:
Full
Name:
Company:
Address:
Relationship:
NO
Previous Employment
Company:
Phone:
Address:
(
)
Supervisor:
Starting
Salary:
Job Title:
Ending
Salary:
$
$
Responsibilities:
Reason for
From:
To:
Leaving:
May we contact your previous supervisor for a
reference?
YES
NO
Company:
Phone:
Address:
(
)
Supervisor:
Starting
Salary:
Job Title:
Ending
Salary:
$
$
Responsibilities:
Reason for
From:
To:
Leaving:
May we contact your previous supervisor for a
reference?
YES
NO
Company:
Phone:
Address:
(
)
Supervisor:
Starting
Salary:
Job Title:
Ending
Salary:
$
$
Responsibilities:
Reason for
From:
To:
Leaving:
May we contact your previous supervisor for a
reference?
YES
NO
Lawn and or Landscape experience not already mentioned
Employer:
From:
To:
Duties:
Other pertinent experience:
Other pertinent experience:
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: