Employment Application – Minor's Garden Center

Applicant Data

How were you referred to us:

Position applying for

Full name

Address

City

State

Zip

Phone

Mobile/Pager/Other

Email

Date available to Start

Social Security Number

Salary Requirements

If you are under 18 years old, can you provide a work permit?

Yes

No

If no, please explain:

Have you ever worked for this company?

Yes

No

If yes, please explain:

Are you legally allowed to work in the United States?

Yes

No

Type of employment desired:

Full-Time

Part-Time

Temporary

Seasonal

Have you ever pleaded guilty, no contest or been convicted of a crime?

Yes

No

If yes, give dates and details

Answering yes to these questions does not constitute an automatic rejection for employment. Date of the offense, seriousness and nature of the violation, rehabilitation and position applied for will be considered.

Driver's license number (if applicable to position)

State

Education History

Name and Location of High School

Did you graduate?

Name and Location of College

Years attended

Degrees completed

Other subjects studied

Trade, Business or Correspondence School

Years attended

Subjects studied

Did you graduate?

Previous Employment (begin with most recent position)

1 (current or most recent position)

Dates of Employment - From

To

Position(s) held

Company name

Address

City

State

Zip

Phone

Supervisor

Title

Responsibilities

Starting Salary and Title

Ending Salary and Title

Reason for leaving

May we contact this employer for a reference?

Yes

No

Recent Employment - 2nd position

Dates of Employment - From

To

Position(s) held

Company name

Address

City

State

Zip

Phone

Supervisor

Title

Responsibilities

Starting Salary and Title

Ending Salary and Title

Reason for leaving

May we contact this employer for a reference?

Yes

No

Recent Employment - 3rd Position

Dates of Employment - From

To

Position(s) held

Company name

Address

City

State

Zip

Phone

Supervisor

Title

Responsibilities

Starting Salary and Title

Ending Salary and Title

Reason for leaving

May we contact this employer for a reference?

Yes

No

Summarize your special skills or qualifications

I certify that the facts contained in this 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 for any damage that may 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 foregoing, unless it is in writing and signed by an authorized company representative. This waiver does not permit the release or use of disability-related or medical information in a manner prohibited by the Americans with Disabilities Act (ADA) and other relevant federal and state laws.

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