Application

Personal Information

Name*

First
Last

Email*

Date*

Address*

Street Address
Address Line 2
City

State
Zip Code

Main Phone*

Alternate Phone

Are you 18 years or older?*

Yes
No

Are you legally able to work in the U.S.A.?*

Yes
No

If hired, you will be required to show that you are authorized to work in the U.S. and to furnish proof of this within 3 days of hire on an I-9 form. Can you do this?*

Yes
No

Wage/Salary Requirements $*

If the job needs it do you have a valid driver's license?*

Yes
No

Have you ever been convicted of felony? (you are not obligated to disclose sealed or expunged records of conviction or arrest)*

Yes
No

Please describe (convictions may not stop you from being eligible for hire)

Have you signed a non-compete agreement or employment contract, which is still in effect at your current/prior employer(s)?*

Yes
No

Please describe

Employment Desired

Position*

Date you can start*

I desire to work:*

Full time
Part time
Temporary

I prefer to work what shift(s):*

Day shift
Evening shift
Any shift

What is your general availability? *

What is your holiday availability?*

Please note here if you will need time off in May

Are you employed now?*

Yes
No

May we inquire of your current employer?

Yes
No

Job requirements

Have you ever worked for a company in our industry before?*

Yes
No

When?*

What company?*

What State?*

Why do you want to work for our company?*

What behaviors are needed to be successful in this job? (Please list 5 or more)*

Can you consistently lift at least 40 pounds?*

Yes
No

Education

Grammar School

Name, location, # of years, graduated? Degree

High School

Name, location, # of years, graduated? Degree

College

Name, location, # of years, graduated? Degree

Other

Name, location, # of years, graduated? Degree

Military Service

U.S. Military

Yes
No

National Guard

Yes
No

Active now?

Yes
No

Branch:

Rank:

Position Title or Summary:

Employment History

List your last three (3) employers, assignments or volunteer activities, starting with the most recent, including military experience. Explain any gaps in employment in the comment section below.

Employer

Hourly rate/salary

Your job title

Employer address

Street Address
City
State / Province / Region
Zip / Postal Code

Country

Employer phone

Supervisor Name

First
Last

Reason for leaving

Summarize the job performed

Add another job*

Yes
No

Employer

Hourly rate/salary

Your job title

Employer address

Street Address
City
State / Province / Region
Zip / Postal Code

Country

Employer phone

Supervisor name

First
Last

Reason for leaving

Summarize the job performed

Add another job*

Yes
No

Employer

Hourly rate/salary

Your job title

Employer address

Street Address
City
State / Province / Region
Zip / Postal Code

Country

Employer phone

Supervisor name

First
Last

Reason for leaving

Summarize the job performed

Comments

Include explanation of gaps of employment, excluding gaps based on pregnancy, health-related reasons, or workers’ compensation disability

Please read carefully before submitting

I certify that all the information submitted by me on this application is true, correct and complete. I understand that if any false information, omissions, or misrepresentations on this form or provided in any interview are discovered, my application may be rejected, and if I am employed, my employment may be terminated at any time. In consideration of my employment, I agree to conform to the company’s rules, regulation and Supervisor’s directions. I understand that this Application for Employment and other Company documents are not contracts of employment. I agree that if I am employed, my employment is at-will, and that my employment, compensation or benefits can be changed or terminated, with or without cause or reason, and with or without notice, at either my or the company’s option. I also understand and agree that the terms and conditions of my employment may be changed, with or without cause or reason, and with or without notice, at any time by the company. I understand that no company representative, other than the President, and then only in writing and signed by both of us, has any authority to enter into an agreement for employment for any specific period of time or to make any agreement contrary to the forgoing. I further authorize the Company to investigate my references, personal history, work record, and other matters related to my suitability for employment, as well as credit or criminal records checking. I authorize all of this information to be provided to the company or their agent and release them from any and all claims, demands or liability arising out of or in any way related to such investigations or disclosure. I understand that if hired I may be required to pass a criminal history records check. Also, if required, I agree to complete, fully participate in and pass a drug and/or alcohol test. Please note that this application is considered current for sixty (60 days. After 60 days, it is necessary to complete another application form in order to be considered for employment

*

I agree

Applicant's Name*

First
Last

Last 4 digits of your social security number*

Please enter a value between 0000 and 9999.

Date*

Garden Inspiration is Everywhere at Heinz Brothers!

Personal Information

Employment Desired

Job requirements

Education

Military Service

Employment History

Please read carefully before submitting

Location

Heinz Brothers
Greenhouse Garden Center

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