Bosworth Garden LLC Job Application

Full Name*

First NameMiddle NameLast Name

Email Address*

example@example.com

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Number of years at this address *

Type in a numerical answer

Social Security Number: OPTIONAL

Your SSN will not be used for any other purpose than running a background check.

Driver's License (State/Number)

Emergency Contact Name *

Relationship to you*

Address*

Type in your emergency contact's address

City/State/ZIP *

Type in the City/State/ZIP of your contact's address.

Phone Number*

Please enter a valid phone number.

Job Position Applied For: *

Salary Desired: *

Enter in as $____ per _____ (Ex. $XX.X per hour)

How did you hear about us*

Please Specify

Do you have any friends or relatives who work here? If yes, please list here: *

Have you applied to our company previously? If yes, please specify when: *

Are you at least 18 years old?*

YesNo

Are you willing to work any shift, including nights and weekends?*

YesNo

If no, please state any limitations:

If you are offered employment, when would you be available to begin work? *

Date

If hired, are you able to submit proof that you are legally eligible for employment in the United States?*

YesNo

Have you been convicted for a crime in the last 7 years?*

YesNo

If yes, please explain:

If considered for hiring, will you agree to provide a criminal background check?*

YesNo

List any skills that may be useful for the job you are seeking and enter the number of years of experience. *

List your current of most recent employment first. Please list all jobs (including self-employment and military service) which you have held, beginning with the most recent, and list/explain any gaps in employment. Copy and answer these prompts for each job in the text box below.

Employer Name:

Supervisor Name:

Address:

City/State/ZIP:

Job Duties:

Reason for Leaving:

Dates of Employment:

List response: *

High School/GED Name and Address *

Did you receive a degree?*

YesNo

College/University Name and Address*

Did you receive a degree?*

YesNo

Please list other training you have received (graduate, technical, vocational), if applicable:

Please indicate any current professional licenses or certifications that you hold, if applicable:

List any two non-relatives who would be willing to provide a reference for you.

Name of Reference #1*

Address of Reference #1 (include City/State/ZIP)*

Phone Number of Reference #1*

Please enter a valid phone number.

Relationship: *

Name of Reference #2*

Address of Reference #2 (include City/State/ZIP)*

Phone Number of Reference #2*

Please enter a valid phone number.

Relationship: *

Upload Your Resume*

If applicable, please provide any other information that you believe should be considered, including whether you are bound by any agreement with any current employer:

I certify that the information provided on this application is truthful and accurate. I understand that providing false or misleading information will be the basis for rejection of my application, or if employment commences, immediate termination.

I authorize Bosworth Garden LLC. to contact former employers and educational organizations regarding my employment and education. I authorize my former employers and educational organizations to fully and freely communicate information regarding my previous employment, attendance, and grades. I authorize those persons designated as references to fully and freely communicate information regarding my previous employment and education.

If an employment relationship is created, I understand that unless I am offered a specific written contract of employment signed on behalf of the organization by its Owner, the employment relationship will be "at-will." In other words, the relationship will be entirely voluntary in nature, and either I or my employer will be able to terminate the employment relationship at any time and without cause. With appropriate notice, I will have the full and complete discretion to end the employment relationship when I choose and for reasons of my choice. Similarly, my employer will have the right. Moreover, no agent, representative, or employee of Bosworth Garden LLC., except in a specific written contract of employment signed on behalf of the organization by its Owner, has the power to alter or vary the voluntary nature of the employment relationship.

I HAVE CAREFULLY READ THE ABOVE CERTIFICATION AND I UNDERSTAND AND AGREE TO ITS TERMS.

Name*

First NameLast Name

Applicant Signature *

Today's Date *

Date

Bosworth Garden LLC. Employment Application

1. Employer Information

2. Applicant Information

3. Emergency Contact

4. Job Position

5. Job History

6. Applicant's Education and Training

7. Applicant References

8. Other Information

Certification