PERSONAL
         
Name  
  First MI Last  
Address  
  Number and Street City State Zip  
Phone Number
Email
Please specify the hours that you are able to work below:
 
  Sun Mon Tue Wed Thu Fri Sat  
   
 
On what date are you available to start working?
Type of position you are seeking?  Salary desired $
Are you 18 years old or older? Yes No If no, How old are you?
Are you employed now? Yes No  
Have you ever worked for us before? Yes No If yes, date
Are you applying for (select one)  Full time    Part time    Seasonal
How did you hear about us? Website
Newspaper 		Friend/Family
Other (please specify)
 
Have you ever been convicted of violating the law, other than traffic related? Yes No
Do you have any physical or mental conditions that would limit your ability to perform the job , or that might cause risk or injury to yourself or others? Yes No
If you answered "Yes" to either questions, please explain:
 
 
EDUCATION
School Name Years Completed Did You Graduate? Diploma / Degree
High School
College
Specialized Training
 
PERSONAL REFERENCES
(Do not list family members)
     
Name: Phone Number: Years Associated:
Name: Phone Number: Years Associated:
Name: Phone Number: Years Associated:
 
EMPLOYMENT EXPERIENCE (Most recent position first)
     
Employer #1 Location Phone #
Supervisor's Name Supervisor's Title Hire Date
Starting Wage Ending Wage Separation Date
Responsibilities
 
Reason(s) for leaving
 
May we contact this employer
If no, why not?
 
Employer #2 Location Phone #
Supervisor's Name Supervisor's Title Hire Date
Starting Wage Ending Wage Separation Date
Responsibilities
 
Reason(s) for leaving
 
May we contact this employer
If no, why not?
 
GREENHOUSE SKILLS INVENTORY  
Greenhouse duties I have performed  
Sowing Seed Growing Plants Watering Plants
Transplanting  Loading Flats Mixing Soil
Record Keeping Direct Sales Cash Register
Do you have any other special skills or licenses you'd like to tell us about?
 

In accordance with Federal and State Fair Employment Laws, a qualified applicant is considered for each position he/she applies for without regard to race, color, religion, sex, national origin, age, height, weight, marital status, veteran status, or the presence of a non-job related medical condition or handicap.
    
     I certify that all of the information furnished on this application is true, complete and correct. I understand and agree that any falsification, misrepresentation, misleading statement, or omission of fact on either this application or during the pre-hire process will be sufficient reason for (1) my not being offered employment; or (2) dismissal at any time from the service of the company if employed. I also understand and agree that employment is subject to my taking a physical examination directly related to the job requirements from a physician, and that in his/her opinion I must be physically and mentally able to perform the work for which I am being considered
     I authorize my former employers to provide the employer any information regarding my employment and medical records, including and in addition to the above, and I release all parties from any liability for any damages which may result from furnishing such information. I also agree to permit the employer to conduct any other background investigative procedures it deems appropriate with respect to my application and, in the event of hire, while employed. I also understand and agree that my employment, compensation and hours of work are for no definite period and may, regardless of the time and manner of payment on my wages and salary, be terminated at any time by me or the employer, with or without cause, and without any previous notice. I also understand and agree that the employer has the right to unilaterally modify and/or terminate any policies, practices, procedures, and standards it has adopted or implemented, to the extent not limited by law. I acknowledge that no representative, other than the employer, has either the power or authority to enter into any agreement for employment for any specified period of time, or to make any representations or agreements contrary to any of the forgoing, unless that agreement is in writing and signed by the employer.