Equinox Valley Nursery, Inc.

Application for Employment

Fields marked with * are required.

Date of Application *

First Name *

Last Name *

Mailing Address *

City *

State *

Zip Code *

Phone *

Position (s) you are applying for *

How did you learn about this position? *

Advertisement, Employment Agency, Walk-in, Friend/Relative (please give name)

What date would you be available to start? *

Name of friend or relative who told you abou this opportunity

Are you applying for *

Full Time

Part Time

Seasonal

Please give your desired rate of pay *

Are you currently employed? *

Have you ever been employed with us? *

Have you ever filed an application with us?

Do you have a valid driver's license? *

Have you been convicted of a felony within the last 7 years? *

Are you prevented from lawfully becoming employed in this country because of Visa or Immigration status? *

If you are under 18 years of age, can you provide required proof of your eligibility to work? *

Are there any circumstances that you are aware of that might adversely affect your ability to perform the job for which you are applying? *

If Yes, please explain

Education

High School

Name of School

Years completed

Year Graduated

College

Name of School

Course of Study

Years Attended

Year Graduated

Other

Name of School or Institution

Area (s) of Study

Degrees or certifications earned

Work Experience

Current Employer

Start Date

End Date

Phone

What is your current hourly rate or salary?

Work Performed

Previous Employer

Start Date

End Date

Phone

What was your current hourly rate or salary?

Work Performed

Reason for Leaving

List any other employment experience.

Additional Information

Authorization

I certify that the information I have provided in this application is true and complete. Any misrepresentations or falsifications are grounds for cancellation of this application. If I have been hired, termination may occur. Furthermore I understand that information on this application will be verified.

I authorize Equinox Valley Nursery, Inc. to investigate/verify all statements contained in this application. I authorize all parties listed on this application to give Equinox Valley Nursery, Inc. information about my background or employment history. I release Equinox Valley Nursery, Inc. from liability for any damage that may result from the release or use of such information.

If hired, I understand that my employment can be terminated with or without cause at any time by Equinox Valley Nursery, Inc. or myself. By checking Yes below I agree to the terms and conditions of this application. Equinox Valley Nursery, Inc. is an equal opportunity employer

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