Application for Employment
Applications will be kept on file for one year.
Personal Information
Name
*
First Name
Middle Name
Last Name
Email
*
example@example.com
Home Phone
*
Please enter a valid phone number.
Other Phone
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long have you been at your present address?
*
Are you legally eligible for employment in the USA?
*
Yes
No
Are you available for full-time work?
*
Yes
No
If not, what hours can you work?
Will you work over time if asked?
*
Yes
No
Have you ever been employed at Bergens?
*
Yes
No
If so, when?
Job Applying For:
*
Pay Expected
*
Other special training or skills:
When can you start?
Personal References
Reference 1
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Reference 2
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
In case of emergency please contact:
Name & Phone
Education
Type a question
*
Name & Locations
Course of Study
# of Years Completed
Did you Graduate?
Degree or Diploma
High School
Trade
College
Membership in Professional or Civic Organizations, US Military, and Special Studies:
Exclude those which may disclose race, color, religion, or national origin.)
Employment Record
Please give accurate, complete employment record. Start with present or most recent employer.
Most Recent Employer
*
Please include dates employed, Employer name, address and phone number, Position, Salary, Wage, Supervisor's name and phone number, and your reason for leaving.
Second Most Recent Employer
*
Please include dates employed, Employer name, address and phone number, Position, Salary, Wage, Supervisor's name and phone number, and your reason for leaving.
Third Most Recent Employer
*
Please include dates employed, Employer name, address and phone number, Position, Salary, Wage, Supervisor's name and phone number, and your reason for leaving.
We may contact the employers listed unless you indicate those you do not want us to contact.
*
Yes, you may contact my previous employers
Please do not contact
If not, what is the reason we may not contact your previous employers?
How did you learn of our organization?
*
DL Newspapers
Lakes Area Press
Job Service
Referral
Other
If referral, by whom?
Acknowledgment
*
"I certify that the facts contained in this application are true and complete to the best of my knowledge and I understand that, if employed, falsified statements on this application shall be grounds for dismissal. Bergen's Greenhouses reserves the right to withdraw any job offer. I understand and agree that, if hired, my employment is for no defined period and may, regardless of the date of payment of my wages and salary, be terminated at any time without any prior notice. I authorize any physician or hospital to release ay necessary information to determine my ability to perform the duties of my job either prior to tentative employment or in the future during employment with Bergen's Greenhouses."
Signature
*
Clear
Submit
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