Job Application PersonalName* First Middle Last Email* AddressStreet* City* State* Zip* Prior AddressPrior Address If less than 2 years at current addressPhoneHome* Cell Social Security # EducationHigh SchoolHigh School City College/Other EducationCollege City Major/Minor Degree GPA College City Major/Minor Degree GPA College City Major/Minor Degree GPA Other job-related educationEmployment HistoryPresent/Last employerName From To Position Salary Address Phone Number Supervisor’s Name ResponsibilitiesReason for leavingNext previous employerName From To Position Salary Address Phone Number Supervisor’s Name ResponsibilitiesReason for leavingNext previous employerName From To Position Salary Address Phone Number Supervisor’s Name ResponsibilitiesReason for leavingReferencesList the names of three people, not related to you, whom you have known at least one year.Name Phone Business or Relation Years known Name Phone Business or Relation Years known Name Phone Business or Relation Years known PreferencesAvailabilityAre you eligible to work in the United States?* Yes No Proof will be required before you can be employedAre you interested in* Full Time Part Time Spring/Seasonal What date are you available?* What type of position are you applying? Wage requirement? Which days are you available?* Select All Monday Tuesday Wednesday Thursday Friday Saturday What hours are you available for Monday?* What hours are you available for Tuesday?* What hours are you available for Wednesday?* What hours are you available for Thursday?* What hours are you available for Friday?* What hours are you available for Saturday?* Which area/areas are you most interested in? Trees & Shrubs Flowers & Vegetables Garden Supplies Cashier Loading Explain your experience in the field you are applying for:OtherAdditional ExperienceDo you have forklift experience? Yes No Certified? Yes No Do you have a valid Utah driver’s license? Yes No Any Restrictions? Yes No Commercial License? Yes NO Can you type? Yes No WPM Ten-Key? Yes No Millcreek HistoryHave you ever applied for a position with Millcreek Gardens? Yes No If yes, explain: Have you ever worked at Millcreek Gardens? Yes No If yes, explain: What brings you to our company?/Referred by: I understand and agree to the following (Initial each box) All information is subject to verification by Millcreek Gardens, Inc. and I authorize investigation af all statements contained in this application I agree that any misrepresentation or falsification of information requested here will be cause for rejection of this application or for subsequent discipline up to and including my dismissal from employment I agree that if my application for employment is accepted the effective date of my employment shall be the time I actually begin to work. If I am employed I agree to be bound by the safety and health rules and regulations of the company, including drugs and alcohol policies and the testing and procedures program and to be bound by the Personnel Policies and Practices Handbook of the company. I agree to abide by the company’s no smoking policy while on the company premises. I agree that I am employed at-will and agree that my employment is not guaranteed for any term and may be terminated by the company or by myself for any reason at any time. I agree that no management official or officer is authorized to make any oral assurance or promise of continued employment other than employment at-will at any time If employed, I agree that my employment will be subject to the conditions of any applicable orientation period established by company policy I agree that I have no health impairments or deficiencies which will prevent me from performing the work for which I am being employed with reasonable accommodation I agree that this application will be considered active for only 30 days, at which time it will terminate. Date* Signature* Δ
