Job Application: Newton Garden Center Team Members

Title: Newton Garden Center Team Members

Fields marked with an asterisk (*) must be filled out before submitting.

Kansas (Pre-Employment questionnaire) We are an equal opportunity employer. All applicants are considered, without regard to race, color, religion, sex, national origin, age, marital or veteran staus, physical or mental disability, or any other legally protected status.

 

Personal Details

Date of Application *
First Name *
Last Name *
E-mail Address *
Current Address *
Permanent Address *
Home Phone Number *
Cell Number

Position Desired

 
Employment Type * Full Time
Part Time
Preferred Work Schedule *
Which Stutzmans location are you applying for?
Date you can start *
Are you willing to work overtime? * Yes
No
Salary range desired
Are you employed now? * Yes
No
Have you ever been employed by our company before? Yes
No
If yes, give date
Are you 18 years of age or older? (Proof of age may be required if employed) Yes
No
Are you legally able to be employed in this country? (Proof may be required if employed) Yes
No
How were you referred to us?
Do you have a current drivers license? Yes
No
 
Commercial license? Yes
No
 
(Do not answer this question unless you have been informed of the requirements of this position.) Are you capable of performing the essential functions of this position as they have been outlined for you? Yes
No
If not, what function(s) can you NOT perform and what accommodation(s) would be required in order for you to perform these function(s)?
 

Education

High School
Years completed & year graduated
 
College
Year completed, year graduated & name of degree/diploma
 
Trade or business school
Years completed, graduated & name of degree/diploma
 
List any honors, certificates, awards or training you have received
 
Note any additional information that may be helpful to us in considering your application
 
What has motivated you to submit an application with Stutzmans Greenhouse?
 
In what way would Stutzmans Greenhouse benefit by having you as an employee?
 

Personal References

Please list three persons who are NOT RELATED to you. List their name, address, phone number, business and years aquainted
 

Employment Experience – start with your present or last job

#1 Dates Employed – From & To, Employer, Supervisor, Address & Phone Number
Position – work performed
Salary – starting and ending
Reason for leaving
May we contact? Yes
No
 
#2 Dates Employed – From & To, Employer, Supervisor, Address & Phone Number
Position – work performed
Salary – starting and ending
Reason for leaving
May we contact? Yes
No
 
#3 Dates Employed – From & To, Employer, Supervisor, Address & Phone Number
Position – work performed
Salary – starting and ending
Reason for leaving
May we contact? Yes
No
Have you ever been convicted of a felony or misdemeanor? Yes
No
(Convictions are not a bar to employment in all cases. Each situation is evaluated individually.) If yes, Please describe:
 
I certify that the facts contained in this application are true and complete to the best of my knowledge and understand that if employed, falsified statements on this application or interview may be grounds for dismissal.
I authorize investigation of all statements contained herein and the references listed above to give you any and all information concerning my previous employment and any pertinent information that they may have, personal or otherwise, and release all parties from all liability from any damage that may result from furnishing same to you.
I understand and agree that, if hired, my employment will be “at will”, without any definite period of time, and may be terminated at any time, with or without cause and with or without prior notice, regarless of the date of payment of my wages or salary.
I understand that as a condition of employment, I may be required to undergo a medical examination and substance test.
Date
Signature
I have read and understood the above privacy policy.
If you have a rÈsumÈ you may upload it here
 

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