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Employment Application This company is an equal opportunity employer dedicated to nondiscrimination in employment. The company selects the best qualified individual for the job based on job-related qualifications regardless of race, age, color, religion, sex, national origin, ancestry, marital status, sexual preference, disability, or any other basis protected by applicable law.

* Indicates a required field.

*First
Middle Initial
*Last

Present Address
*Street Number
*City
*State
*Zip

Permanent Address (if different)
Street Number
City
State
Zip

Home Phone (include area code)
*
Message Phone (include area code)

Email Address

What position are you applying for?
Are you able to perform the essential functions of the position with or without accommodations? Yes No
Date you can start
Salary Desired
Do you prefer: full-time part-time
Are you legally eligible for employment in the United States of America? Yes No
If hired, can you furnish proof that you are over 18 years of age? Yes No
Are you employed now? Yes No
If yes, where?
Can we contact your present employer? Yes No
Have you ever applied to or worked for Wheatfield Nursery Inc. before? Yes No
If yes, when?
Do you have any relatives or friends curently working for Wheatfield Nursery Inc.? Yes No
If yes, who?
Have you served in the United States Armed Forces? Yes No
If yes, what branch?
Have you ever pled guilty or "no contest" to, or been convicted of, a misdemeanor or felony? Yes No
If yes, what give date(s) and details
Answering yes to these questions does not constitute an automatic bar to employment. Factors such as age and time of the offense, seriousness and nature of the violation, and rehabilitation will be taken into account.

Education

	Name of School	City and State	# of years completed
High School			1 2 3 4 5 6
Did you Graduate?	Yes No	Degree Earned
	Name of School	City and State	# of years completed
College			1 2 3 4 5 6
Did you Graduate?	Yes No	Degree Earned
	Name of School	City and State	# of years completed
Graduate			1 2 3 4 5 6
Did you Graduate?	Yes No	Degree Earned
Additional training, skills, experience, and special achievements relevant to position:

Employment:

List last employment first.

Employer name	Address
Position Title/Duties	Telephone Number(s)
Supervisor	Dates Employed From To
Reason for Leaving

Employer name	Address
Position Title/Duties	Telephone Number(s)
Supervisor	Dates Employed From To
Reason for Leaving

Employer name	Address
Position Title/Duties	Telephone Number(s)
Supervisor	Dates Employed From To
Reason for Leaving

Employer name	Address
Position Title/Duties	Telephone Number(s)
Supervisor	Dates Employed From To
Reason for Leaving

Have you ever been terminated or asked to resign from any job? Yes No

If yes, please explain:

Do you have adequate transportation to and from work? Yes No

What types of computers, equipment, and machines do you have experience operating?

What professional licenses, certifications or registrations do you have?

References:

Please list work related references only

Name	City, State	Daytime Phone Number

This application will be considered active for a maximum thirty (30) days. If you wish to be considered for employment after that time, you must reapply.