Miracle Application

Employment Application

Equal Employment Opportunity
Full Name:*

First NameMiddle NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:*

Area CodePhone Number
Birth Date

MonthDayYear
E-mail Address:
Date Available

MonthDayYear
Date
Social Security Number
Salary Desired
Position Applied For
Are you a US Citizen?

YesNo
If No, are you authorized to work in the U.S.?

YesNo
Have you ever worked for this MIracle Landscape?

YesNo
If yes, when?
have you ever been convicted of a felony?

YesNo
If yes, explain:
have you ever been convicted of a Misdemeanor?

YesNo
If yes, explain:
Are you on probation?

YesNo
How were you referred to us?*

Walk-InEmployeeNewspaper AdFacebookPlacement OfficeJob FairWebsiteOther (please specify)
Other:
Education:
High School:
Address:
From:

MonthDayYear
Date
to:

MonthDayYear
Date
Did you graduate?

YesNo
Diploma
college:
Address:
From:

MonthDayYear
Date
to:

MonthDayYear
Date
Did you graduate?

YesNo
Diploma
other:
Address:
From:

MonthDayYear
Date
to:

MonthDayYear
Date
Did you graduate?

YesNo
Diploma
Job Skills & Training
Describe your skills:
Training or Certifications:
References

Please list two (2) references that are familiar with your work life.
Reference 1
Name:

First NameLast Name
Relationship:
company:
Phone Number

Area CodePhone Number
Years Known:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Reference 2
Name:

First NameLast Name
Relationship:
company:
Phone Number

Area CodePhone Number
Years Known:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Previous Employment
Company:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Supervisor:
job title:
starting salary
ending salary
responsibilities
from

MonthDayYear
Date
to

MonthDayYear
Date
reason for leaving
may we contact your previous supervisor for a reference?

YesNo
Company:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Supervisor:
job title:
starting salary
ending salary
responsibilities
from

MonthDayYear
Date
to

MonthDayYear
Date
reason for leaving
may we contact your previous supervisor for a reference?

YesNo
Company:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Supervisor:
job title:
starting salary
ending salary
responsibilities
from

MonthDayYear
Date
to

MonthDayYear
Date
reason for leaving
may we contact your previous supervisor for a reference?

YesNo
Military Service
Branch
from

MonthDayYear
Date
to

MonthDayYear
Date
rank at discharge
type of discharge
if other than honorable, explain:
Voluntary Information

This information is being requested in accordance with federal regulations. This information is voluntary and will not be used when considering you for employment with our company.
Racial or ethnic group

American Indian/AlaskanAsian/Pacific IslanderBlack/African AmericanHispanic/LatinoWhite/CaucasianOther
Gender

FemaleMale
MIlitary Service

Pre-Vietnam EraVietnam EraPost-Vietnam EraDisabled Veteran
Upload Resume:
Disclaimer and Signature

I CERTIFY THAT MY ANSWERS ARE TRUE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. IF THIS IS APPLICATION LEADS TO MY EMPLOYMENT, I UNDERSTAND THAT FALSE OR MISLEADING INFORMATION IN MY APPLICATION OR INTERVIEW MAY RESULT IN MY RELEASE.
Initial
Date

MonthDayYear
Date
Should be Empty:

Employment Application

Disclaimer and Signature