Employment Application

Employment Application

1410 North 1900 West, Farr West, UT 84044 - (801) 782-4149
Applicant Information
Full Name*

First & Middle NameLast Name
Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Format: (000) 000-0000.
Email*
Date Available*

MonthDayYear
Social Security No.*
Desired Area*
(i.e. Storefront, Greenhouse, Nursery or Any)
Desired Salary*
YesNo
YesNo
YesNo
If yes, when?

MonthDayYear
YesNo
If yes, explain:
Education
High School Diploma or GEDSome CollegeAssociates DegreeBachelors DegreeMasters Degree
High School Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years Attended
College Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Degree 1:
Years Attended
Degree 2:
Years Attended
References

Please list 3 professional references.
Full Name:   First Name   Last Name    Relationship:
Company:      Phone:   Area Code   Phone Number
Address:   Street Address   Address Line 2   City   State   Zip
Full Name:   First Name   Last Name    Relationship:
Company:      Phone:   Area Code   Phone Number
Address:   Street Address   Address Line 2   City   State   Zip
Full Name:   First Name   Last Name    Relationship:
Company:      Phone:   Area Code   Phone Number
Address:   Street Address   Address Line 2   City   State   Zip
Previous Employment

(i.e. most recent)
Company:   *   Phone:   Area Code*   Phone Number*
Address:   Street Address*   Address Line 2*   City*   State*   Zip*
Supervisor:   First Name*   Last Name*
Job Title:   *   Starting Salary:   *   Ending Salary:   *
Responsibilities:   *
From:   *   To:   *   Reason for Leaving:   *
May we contact your previous supervisor for a reference?    Yes    No*
Company:   *   Phone:   Area Code*   Phone Number*
Address:   Street Address*   Address Line 2*   City*   State*   Zip*
Supervisor:   First Name*   Last Name*
Job Title:   *   Starting Salary:   *   Ending Salary:   *
Responsibilities:   *
From:   *   To:   *   Reason for Leaving:   *
May we contact your previous supervisor for a reference?    Yes    No*
Company:      Phone:   Area Code   Phone Number
Address:   Street Address   Address Line 2   City   State   Zip
Supervisor:   First Name   Last Name
Job Title:      Starting Salary:      Ending Salary:
Responsibilities:
From:      To:      Reason for Leaving:
May we contact your previous supervisor for a reference?    Yes    No
Military Service
YesNo
Branch
If no longer active, what years did you serve?
Rank at Discharge:
If still serving, answer N/A
Type of Discharge
If other than honorable, explain:
Disclaimer & Signature

I certify that my answers are true and complete to the best of my knowledge. If this application leads to employment, I understand that false or misleading information, in my application or interview, may result in my release.
Signature*
Date*

MonthDayYear
Additional Disclaimer & Signature

Upon acceptance of employment with Jerry's Nursery, I understand that my tenure and/or employment is based on seasonal and promotional business decisions, of the management of Jerry's Nursery, and as such I understand I am being hired as a seasonal employee.
Signature*
Date*

MonthDayYear
Work Availability
Select the hours you are available to work.*
Resume & Cover Letter
Upload a resume and/or cover letter (optional but recommended).

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Employment Application

Applicant Information

Education

References

Previous Employment

Military Service

Disclaimer & Signature

Additional Disclaimer & Signature

Work Availability

Resume & Cover Letter