Osborne Farm & Garden Centers - Employment Application

Date of Application

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability or sexual orientation.

Name

First NameLast Name

Are you under age 16?

Are you over 18 years of age? (If NO - you will be requested to submit state required work/age certificates)

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

When is the best time to call?

Day/Date/Time. Example: Wed 4/30 6pm

Email

example@example.com

Which location are you applying at?

Position you are applying for

What type of employment are seeking?

Can you work a flexible schedule - where days/hours are different each week?

What days are you willing to work?

What hours are you able to work?

Date Available to Start

Date

Have you ever been known by a different name?

If yes - what is it?

Have you ever been convicted of or pleaded guilty to a felony?

If yes, please explain.

A conviction does not automatically disqualify you from employment.

Are you legally eligible to work in the United States. (Proof of Eligibility documentation must be provided at the time of hire as required by law.)

How many employers have you had in the past 5 years?

Have you ever worked in a retail store?

Have you ever been involuntarily terminated by an employer?

If yes - please explain all occurrences

May we contact your current employer?

May we contact your former employer?

List your current or most recent employer first. Include military service and/or any periods of self-employment. You must account for your three (3) most recent employers or a maximum of five (5) years of your most recent employment history.

Present or last employer 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.

Last position held

Last supervisor's name

First NameLast Name

Dates employed

Example: MM/DD/YY to MM/DD/YY

Reasons for leaving

Be as specific as possible

What did you like best about this job?

What did you like least about this job?

Employer number 2

Address number 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone number 2

Please enter a valid phone number.Format: (000) 000-0000.

Position held number 2

Supervisor number 2 Name

First NameLast Name

Dates employed

Example: MM/DD/YY to MM/DD/YY

Reasons for leaving number 2

Be as specific as possible

What did you like best about this job?

What did you like least about this job?

Employer number 3

Address number 3

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone number 3

Please enter a valid phone number.Format: (000) 000-0000.

Position held number 3

Supervisor number 3 Name

First NameLast Name

Dates employed

Example: MM/DD/YY to MM/DD/YY

Reasons for leaving number 3

Be as specific as possible

What did you like best about this job?

What did you like least about this job?

From - To Dates

Example: MM/DD/YY to MM/DD/YY

Reason

From - To Dates

Example: MM/DD/YY to MM/DD/YY

Reason

High School Name

High School Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Graduated?

Degree?

College/Vocational Name

College/Vocational Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Graduated?

Degree/Certificate?

Graduate School

Graduate Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Graduated?

Degree?

Other Education, Degrees, Certificates

Please be specific

Special/Technical Skills

Please list the skills you have and, where appropriate, type of program used or speed

Personal Reference 1 Name

First NameLast Name

Personal Reference Phone Number 1

Please enter a valid phone number.Format: (000) 000-0000.

Personal Reference Address 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Personal Reference 2 Name

First NameLast Name

Personal Reference Phone Number 2

Area CodePhone Number

Personal Reference Phone Number 2

Please enter a valid phone number.Format: (000) 000-0000.

Personal Reference Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Professional Reference 1

Professional Reference Phone Number 1

Please enter a valid phone number.Format: (000) 000-0000.

Professional Reference Address 1

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Professional Reference Name 2

Professional Reference Phone Number 2

Please enter a valid phone number.Format: (000) 000-0000.

Professional Reference Address 2

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Full Name

First NameLast Name

Relation To You

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Please Read and Sign:

Please read carefully before signing.

By my signature below, I promise that the information provided in this employment application is true and complete, and I understand that any false or misleading information or omissions may disqualify me from further consideration for employment and may lead to my immediate discharge from employment if discovered at a later date. I agree to immediately notify Osborne’s Farm & Garden Centers, LLC if I should be convicted of a felony or any crime involving dishonesty, breach of trust, controlled substances, sexual misconduct, abuse or violence, while my application is pending or during my period of employment if hired.

I understand that the company may investigate my work and personal history and verify all data given on this application, or related papers, and in interviews. In addition, I understand that the company reserves the right to conduct background investigations to determine my qualifications for employment. I authorize any person, school, current employer, past employer(s) and organizations named in this application to provide Osborne’s Farm & Garden Centers, LLC. with any information and opinions requested by Osborne’s Farm & Garden Centers, LLC in connection with any application, and I release such parties from any liability in making such statements.

I understand that this application does not create a contract of employment. I understand that, if hired, I am obligated to comply with any and all current and subsequently adopted Osborne’s Farm & Garden Centers, LLC policies. I understand and agree that, if hired, my employment is for no definite period of time, and may, regardless of the date of payment of my wages or salary, be terminated at any time for any reason, with or without notice. I understand that no person other than the member of the Board of Directors of Osborne’s Farm & Garden Centers, LLC is authorized to change any terms mentioned in this employment

Signature

Date

Please verify that you are human

Employment Application

Applicant Data

Position Desired

Work Schedule

Employment History

Periods of Unemployment During the Past Three Years

Education Information

Personal and Professional References

Emergency Contact