APPLICATION FOR EMPLOYMENT Dutch Mill

APPLICATION FOR EMPLOYMENT
www.dutchmillgreenhouse.com (937) 642-0511
P.O. Box 670 18443 St. Rt. 4 North
Last
First
MI
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

City, ST & ZipState / Province

Postal / Zip Code
Are you 18 or older?

YesNo
Have you ever been convicted of a crime ?

YesNo
Yes

If yes, please explain:No
If yes, please explain
Salary Desired
Date Available

MonthDayYear
Date
Would you be willing to consent to a drug test?

YesNo
Have you been employed here before?

YesNo
What position are you applying for?
Hours Available Per Week
WAREHOUSE POSITIONS ONLY - Please Read The Following

GREENHOUSE POSITIONS ONLY - Please Read The Following

If applying for a position as warehouse laborer, you will be required to do heavy lifting (60 lbs. or under The weather conditions in the warehouse in the winter are extremely cold and you will be required to dress appropriately. You will also be required to enter coolers and freezers with temperatures ranging from 28°F to 86°F.

If applying for a position in the greenhouse/garden center, you will be required to do heavy lifting (60 lbs. or under The weather conditions range from 28°F to 100°F temperatures. You will be required to dress appropriately.
Please List Three Persons Not Related To You, Whom You Have Known At Least One Year
Employer
Address

Address

Street Address Line 2

City, ST, ZIPState / Province

Postal / Zip Code
Name of Immediate Supervisor
Position/Job Title
Pay
Employment
From
To
May We Contact?

YesNo
Telephone
Reason for Leaving
Employer
Address

Address

Street Address Line 2

City, ST, ZIPState / Province

Postal / Zip Code
Name of Immediate Supervisor
Position/Job Title
Pay
Dates of

MonthDayYear
Date
Employment
From
To
May We Contact?

YesNo
Telephone
Reason for Leaving
List special skills, training, or areas of special study or research work
By signing below, 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.

I authorize investigation of all statements contained herein and the references listed to give you any and all information concerning my previous employment and any pertinent information they may have, and release all parties from liability for any damage that may result from furnishing same to you.
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APPLICATION FOR EMPLOYMENT

Please List Three Persons Not Related To You, Whom You Have Known At Least One Year