Employment Application |

Applicant Information

Application Date:  (mm / dd / yyyy)

Last Name:

First Name:

M.I.

Street Address:

Apartment/Unit#:

City:

State:

Zip Code:

Phone Number:

Email Address:

Date Available:

Position Desired:
Full Time  Part Time  Full or Part Time

Position Applying For: 

Are you a citizen of the United States?  Yes  No

  -  If no, are you authorized to work in the US?    Yes  No

Have you ever worked for this company?  Yes  No

  -  If yes, when? 

Have you ever worked for a Florist?  Yes  No

  -  If yes, where and for how long? 

Have you been convicted of a felony?  Yes  No

  -  If yes, please explain:
     

Education

High School: 

Address: 

From:    To: 
Did you Graduate?  Yes  No

Degree: 

College: 

Address: 

From:    To: 
Did you graduate?  Yes  No

Degree: 

Other: 

Address: 

From:    To: 
Did you graduate?  Yes  No

Degree: 

References

Please list three professional references:

Full Name: 

Relationship: 

Company: 

Phone:

Full Name: 

Relationship: 

Company: 

Phone: 

Full Name: 

Relationship: 

Company: 

Phone: 

Previous Employment

Company: 

Phone: 

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From: 

To: 

Reason For Leaving:

May we contact your previous supervisor for a reference?  Yes  No

Company: 

Phone: 

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From: 

To: 

Reason For Leaving:

May we contact your previous supervisor for a reference?  Yes  No

Company: 

Phone: 

Address:

Supervisor:

Job Title:

Starting Salary:

Ending Salary:

Responsibilities:

From: 

To: 

Reason For Leaving:

May we contact your previous supervisor for a reference?  Yes  No

Military Service

Branch: 

From: 

To: 

Rank at Discharge: 

Type of Discharge: 

  -  If other than Honorable, explain:
     

Disclaimer and Submission

I certify that my answers are true and complete to the best of my knowledge.

If this application leads to employment, I understand that false or misleading information in my application or interview may result in my release. I authorize investigation of all statements contained on this application and included resume. I further authorize you to contact my references and previous employers to verify the information contained herein.

Wesley Berry Flowers is an Equal Opportunity Employer.