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Canoyer Garden Center Employment Application
An Equal Opportunity Employer
All applicants are considered without regard to race, color, gender, religion, national origin, age, marital or
veteran status, mental or physical disability unrelated to job performance or any other legally protected
status.
Personal Information
____________________________________ ______________________________ ______
Last Name
First Name
M.I.
_______________________________________ _____________________ _______ __________ (_____) ______-________
Address
City
State
Zip
Phone
Employment Desired
Position applying for: _________________________________________Salary Desired______________
What hours are you available to work? _____________________________________________________
If hired, when could you start? ___________________________________________________________
If hired, can you present evidence of your U.S. citizenship or proof of your legal right to live
and work in this country? .............................................................................................. Yes
No
Are you able to perform the essential functions of the job for which you are applying, either
with or without reasonable accommodation? ............................................................... Yes
No
If no, describe the functions that cannot be performed.
____________________________________________________________________________________
Have you ever been convicted of a criminal offense (felony or serious misdemeanor)?.... Yes
If yes, state nature of the crime(s), when and where convicted.
No
_____________________________________________________________________________________________
Education, Training, and Experience
High ____________________________________________ Year Graduated/Anticipated Graduation ________
School Name
College/ _________________________________________ Year Graduated/Anticipated Graduation ________
University Name
____________________________________________
Subject of Study
Military Experience _____________________________________________________________________________
Employment History
List below all present and past employment starting with your most recent employer.
1.
___________________________________________________________________ (_____) ______-_________
Name of Employer
Telephone No.
______________________________________________________ __________________________ _________ ___________
Address
City
State
Zip
Dates of Employment: ___________________ ___________________ Salary: ________________
From Starting
To Ending
_____________________________________________________________________________________________________
Your Position and Duties
_____________________________________________________________________________________________________
Reason for Leaving
May we contact this employer for a reference? ........ Yes
No
2.
___________________________________________________________________ (_____) ______-_________
Name of Employer
Telephone No.
______________________________________________________ __________________________ _________ ___________
Address
City
State
Zip
Dates of Employment: ___________________ ___________________ Salary: ________________
From Starting
To Ending
_____________________________________________________________________________________________________
Your Position and Duties
_____________________________________________________________________________________________________
Reason for Leaving
List Additional Employment in the last 5 years.
3. ________________________________________________________________________________________
4. ________________________________________________________________________________________
5. ________________________________________________________________________________________
CERTIFICATION & AUTHORIZATION
I hereby certify that all statements made in this application are true and correct to the best of my knowledge and
belief. I understand that any misrepresentations or omissions of facts in this application are grounds for
disqualification from further consideration or for dismissal from employment.
I authorize the company to inquire into my educational, professional and past employment history references as
needed to research my qualifications for this position.
If employed, I agree to conform to the rules, regulations and policies of the company. I understand that I will be an
employee “at will” and either the company or I may terminate my employment relationship at any time for any reason
not in violation of law.
I hereby acknowledge that I have read and fully understand the forgoing and seek employment under these
conditions.
_____________________________________________
Signature of Applicant
____________________
Date