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R.N.H. Landscape - Application for Employment Pre Employment Questionnaire       Equal Opportunity Employer

R.N.H. Landscape and Design, Inc.    P.O. Box 794    Sudbury, Massachusetts 01776 Phone (978) 443-7699   Fax (978) 443-3797 Type the requested information, Print, Sign, Date, then Mail or Fax.

First Name: Last Name: Initial: Social Security Number: Present Address: City: State: Zip: Permanent Address: City: State: Zip: Phone Number: Referred by: Position Desired: Date you can start: Salary Desired: Are you employed: Yes No   If so, may we contact your present employer?: Yes No Have you applied to this company before?: Yes No When: Do you have a drivers license?: Yes No Please describe your previous experience: School Name / Location Years Attended Did you graduate? Subjects Studied Grammar Yes No High Yes No College Yes No Trade Yes No

Former Employers - Please list last 4 employers starting with last one first. Date Month/Year Name / Address Salary Position Reason for leaving

References - Give below the names of three persons, not related to you, who have known you for at least one year. Name Address Business Years Known

I certify that the facts contained in the application are true and complete to the best of my knowledge and understand that, if employed, falsified statements on this application shall be grounds for dismissal. I authorize investigation of all statements contained herein and the references and 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 the company from all liability from any damage that might result from utilization of such information. I also understand and agree that no representative of the company has any authority to enter into any agreement for employment for any specified period of time, or to make any agreement contrary to the forgoing, unless it is in writing and signed by an authorized company representative. Signature:______________________________ Date:______________