Application for Employment

Application for Employment

Applications will be kept on file for one year.
Personal Information
Name

First NameMiddle NameLast Name
Email
example@example.com
Home Phone
Please enter a valid phone number.Format: (000) 000-0000.
Other Phone
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you been at your present address?
Are you legally eligible for employment in the USA?
Are you available for full-time work?
If not, what hours can you work?
Will you work over time if asked?
Have you ever been employed at Bergens?
If so, when?
Job Applying For:
Pay Expected
Other special training or skills:
When can you start?
Personal References
Reference 1
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Reference 2
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
In case of emergency please contact:
Name & Phone
Education

Type a question

Rows	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.
If not, what is the reason we may not contact your previous employers?
How did you learn of our organization?

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
Should be Empty:

Application for Employment

Personal Information

Personal References

Education

Employment Record