Employment Application

Application for At-Will Seasonal Employment

We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, or any other legally protected status.

Name

Date

Address

Street Address

City/Town

State/Province

ZIP/Postal Code

Phone

Are you 18 years or older?

Yes

Date you can start work

Are you lawfully entitled to be employed in the United States?

Yes

Times you are generally available to work each week

Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday
Sunday hours	Monday hours	Tuesday hours	Wednesday hours	Thursday hours	Friday hours	Saturday hours

How many hours do you prefer to work each week?

Other (preference/experience)

References: List three individuals not related to you whom you have known for at least a year.

Name	Contact Information	Relationship
Name	Contact Information	Relationship
Name	Contact Information	Relationship
Name	Contact Information	Relationship

Do you know anyone who is or was employed by Van Atta's?

Yes

If so, who?

Education History

Education	Name of School	School Location	Course of Study	Degree/Diploma Completed?
High School	School Name	School Location	Course of Study	Did you get a diploma/degree? Yes No
College	School Name	School Location	Course of Study	Did you get a diploma/degree? Yes No
Other	School Name	School Location	Course of Study	Did you get a diploma/degree? Yes No

Please describe any special skills, training, management experience, equipment operation, or other qualifications you have that may be relevant to us in considering your application:

Employment History

Are you currently employed?

Yes

If so, may we contact your current employer?

Yes

Please list your previous employers (most recent first):

Dates of employment	Name, Location, and Phone Number of Employer	Last Position Held	Reason for Leaving
Dates of employment	Employer Information	Last Position Held	Reason for Leaving
Dates of employment	Employer Information	Last Position Held	Reason for Leaving
Dates of employment	Employer Information	Last Position Held	Reason for Leaving

May we contact any of your previous employers?

Yes

If yes, which ones?

Have you ever been convicted of a crime other than a minor traffic violation?

Yes

If yes, please explain:

Please read the following statement carefully before signing to indicate your understanding:

I understand that prior to being offered employment I may be asked to take an employment examination. If I have a disability that will affect my ability to take the test, I will so inform Van Atta’s Greenhouse & Flower Shop prior to the administration of the test so that reasonable accommodation can be made. Van Atta’s reserves the right to require medical documentation regarding the need for accommodation.

I certify that the information I have entered on this application is true and complete to the best of my knowledge. I understand that, if employed, falsified statements on this application may result in termination.

I understand and agree that, if hired, my employment is for no definite period and may, regardless of the date of payment of my wages or salary, be terminated with or without cause, at any time, with or without notice.

I authorize investigation of all statements made on this application for employment-related purposes. I release the listed references and employers (unless I have noted their exception above) to provide all applicable information they have. I hereby release these references and employers from all liability for any information they provide to Van Atta’s.

Signature

Sign above

Date